Provider Demographics
NPI:1770763633
Name:NORTH ORANG COUNTY PEDIATRICS CHILES DAN W ET AL GEN PTRS
Entity type:Organization
Organization Name:NORTH ORANG COUNTY PEDIATRICS CHILES DAN W ET AL GEN PTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BACHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-528-5112
Mailing Address - Street 1:895 E YORBA LINDA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3695
Mailing Address - Country:US
Mailing Address - Phone:714-528-5112
Mailing Address - Fax:714-996-9355
Practice Address - Street 1:895 E YORBA LINDA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3695
Practice Address - Country:US
Practice Address - Phone:714-528-5112
Practice Address - Fax:714-996-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA234802080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26098OtherMEDICAL LIC NUMBER
CAA23480OtherMEDICAL LIC NUMBER
CAA21067OtherMEDICAL LIC NUMBER
CAGR0040180Medicaid
CAGR0024380Medicaid
CAGR0024380Medicaid
CAGR0040180Medicaid
CAA24725Medicare UPIN