Provider Demographics
NPI:1912257478
Name:OC PHYSICIANS GROUP
Entity Type:Organization
Organization Name:OC PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-336-4317
Mailing Address - Street 1:17911 SKY PARK CIR
Mailing Address - Street 2:SUITE L
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6322
Mailing Address - Country:US
Mailing Address - Phone:949-336-4646
Mailing Address - Fax:
Practice Address - Street 1:17911 SKY PARK CIR
Practice Address - Street 2:SUITE L
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6322
Practice Address - Country:US
Practice Address - Phone:949-336-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21715111NR0400X
CAA35456208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty