Provider Demographics
NPI:1952367542
Name:NORTHERN ORANGE COUNTY ENT MEDICAL CORP
Entity Type:Organization
Organization Name:NORTHERN ORANGE COUNTY ENT MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-441-0133
Mailing Address - Street 1:1955 SUNNYCREST DR
Mailing Address - Street 2:STE 108
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3654
Mailing Address - Country:US
Mailing Address - Phone:714-441-0133
Mailing Address - Fax:714-441-1082
Practice Address - Street 1:1955 SUNNYCREST DR
Practice Address - Street 2:STE 108
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3654
Practice Address - Country:US
Practice Address - Phone:714-441-0133
Practice Address - Fax:714-441-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73421207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16083AMedicare PIN
WG73421BMedicare ID - Type UnspecifiedAN NUMBER
G47905Medicare UPIN
W16083Medicare ID - Type UnspecifiedPROV NUMBER