Provider Demographics
NPI:1669554861
Name:ORANGE COUNTY NEUROLOGY,INC
Entity type:Organization
Organization Name:ORANGE COUNTY NEUROLOGY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-365-9128
Mailing Address - Street 1:26800 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 455
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6384
Mailing Address - Country:US
Mailing Address - Phone:949-365-9128
Mailing Address - Fax:949-429-8073
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 455
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-365-9128
Practice Address - Fax:949-429-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86267174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA862670Medicaid
CAH81044Medicare UPIN
CAW19458Medicare PIN