Provider Demographics
NPI:1811080526
Name:CHILDREN'S HOSPITAL OF ORANGE COUNTY
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL OF ORANGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT MEDICAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:SANDIP
Authorized Official - Middle Name:
Authorized Official - Last Name:GODAMBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-509-8413
Mailing Address - Street 1:1201 W LA VETA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-997-3000
Mailing Address - Fax:714-532-8753
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4203
Practice Address - Country:US
Practice Address - Phone:714-997-3000
Practice Address - Fax:714-532-8753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC31404FMedicaid
CA3253OtherBLUE CROSS
CA0001OtherCHAMPUS
CACHOCOtherUNIVERSAL CARE
CAZZT41404FMedicaid
CAZZZD3004ZOtherBLUE SHIELD
CAZZT41404FMedicaid