Provider Demographics
NPI:1194908293
Name:PEDIATRIC SURGICAL SPECIALISTS OF ORANGE COUNTY
Entity type:Organization
Organization Name:PEDIATRIC SURGICAL SPECIALISTS OF ORANGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-361-4480
Mailing Address - Street 1:1120 W LA VETA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4231
Mailing Address - Country:US
Mailing Address - Phone:714-361-4480
Mailing Address - Fax:714-361-4490
Practice Address - Street 1:1120 W LA VETA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4231
Practice Address - Country:US
Practice Address - Phone:714-361-4480
Practice Address - Fax:714-361-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG794792086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty