Provider Demographics
NPI:1366725590
Name:PEDIATRIC DERMATOLOGY OF ORANGE COUNTY PC
Entity type:Organization
Organization Name:PEDIATRIC DERMATOLOGY OF ORANGE COUNTY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:METZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-336-6569
Mailing Address - Street 1:3500 BARRANCA PKWY
Mailing Address - Street 2:STE 160
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8226
Mailing Address - Country:US
Mailing Address - Phone:949-336-6569
Mailing Address - Fax:949-336-6570
Practice Address - Street 1:3500 BARRANCA PKWY
Practice Address - Street 2:STE 160
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8226
Practice Address - Country:US
Practice Address - Phone:949-336-6569
Practice Address - Fax:949-336-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty