Provider Demographics
NPI:1851059794
Name:ORANGE COUNTY PEDIATRIC UROLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:ORANGE COUNTY PEDIATRIC UROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-456-7005
Mailing Address - Street 1:505 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4568
Mailing Address - Country:US
Mailing Address - Phone:714-509-3919
Mailing Address - Fax:
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4203
Practice Address - Country:US
Practice Address - Phone:714-503-8504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty