Provider Demographics
NPI:1720516628
Name:OC TRAUMA INC
Entity Type:Organization
Organization Name:OC TRAUMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-457-7900
Mailing Address - Street 1:26732 CROWN VALLEY PKWY STE 351
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6374
Mailing Address - Country:US
Mailing Address - Phone:949-364-1007
Mailing Address - Fax:949-588-8719
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 351
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6374
Practice Address - Country:US
Practice Address - Phone:949-364-1007
Practice Address - Fax:949-588-8719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH ORANGE COUNTY SURGICAL MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty