| Thc - Orange County, Llc | |
|
1940 El Cajon Blvd San Diego CA 92104 | |
| (619) 543-4500 | |
| (619) 294-2979 |
| Full Name | Thc - Orange County, Llc |
|---|---|
| Speciality | General Practice |
| Location | 1940 El Cajon Blvd, San Diego, California |
| Authorized Official Name and Position | Mostafa Adam Darvish (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7148934541 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thc - Orange County, Llc 1940 El Cajon Blvd San Diego CA 92104-1005 Ph: (619) 543-4500 | Thc - Orange County, Llc 1940 El Cajon Blvd San Diego CA 92104 Ph: (619) 543-4500 |
| NPI Number | 1093947251 |
|---|---|
| Provider Enumeration Date | 08/20/2009 |
| Last Update Date | 07/19/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093947251 | NPI | - | NPPES |
| ZZT30220I | Medicaid | CA | |
| 052035 | Other | CA | BLUE CROSS |
| ZZT40220I | Other | CA | HEALTH NET |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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