Provider Demographics
NPI:1740281617
Name:ORANGE COUNTY PHYSICIANS HEARING SERVICES
Entity type:Organization
Organization Name:ORANGE COUNTY PHYSICIANS HEARING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:949-364-4361
Mailing Address - Street 1:26726 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6364
Mailing Address - Country:US
Mailing Address - Phone:949-364-4361
Mailing Address - Fax:949-364-7124
Practice Address - Street 1:26726 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6364
Practice Address - Country:US
Practice Address - Phone:949-364-4361
Practice Address - Fax:949-364-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABR501691261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000800Medicaid
CAGAU000800Medicaid