| |
353 S Main St Orange CA 92868-3833 | |
(714) 771-8006 | |
(714) 744-8630 |
Full Name | |
---|---|
Speciality | Clinic/center - Community Health |
Location | 353 S Main St, Orange, California |
Authorized Official Name and Position | Alan H Garrett (CHIEF OPERATING OFFICER) |
Authorized Official Contact | 7147718000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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353 S Main St Orange CA 92868-3833 Ph: (714) 771-8006 | 353 S Main St Orange CA 92868-3833 Ph: (714) 771-8006 |
NPI Number | 1962625202 |
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Provider Enumeration Date | 04/11/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1962625202 | NPI | - | NPPES |
CMM70367F | Medicaid | CA | |
EAP70367F | Other | CA | (EAPC) EXPANDED ACCESS PR |
G93665-01 | Other | CA | DENTI-CAL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QC1500X | Clinic/center - Community Health | (California) | Primary |
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