Provider Demographics
NPI:1104066406
Name:ORANGE COUNTY CHILDREN'S MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:ORANGE COUNTY CHILDREN'S MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLADELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-218-2869
Mailing Address - Street 1:26691 PLAZA STE 120A
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6347
Mailing Address - Country:US
Mailing Address - Phone:949-600-8100
Mailing Address - Fax:949-600-8101
Practice Address - Street 1:26691 PLAZA STE 120A
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6347
Practice Address - Country:US
Practice Address - Phone:949-600-8100
Practice Address - Fax:949-600-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79073208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty