# CHILDREN'S HOSPITAL OF ORANGE COUNTY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CHILDREN'S HOSPITAL OF ORANGE COUNTY
- **Other names:** CS Miscellaneous Physician Services
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1194118018
- **Legal business name:** CHILDREN'S HOSPITAL OF ORANGE COUNTY
- **Authorized official:** MARK KELLY (DIRECTOR, BUSINESS SERVICES)
- **Authorized official phone:** (714) 509-7964

## Contact information

- **Practice address:** 1201 W LA VETA AVE, ORANGE, CA 92868-4203
- **Practice address phone:** (714) 509-8649
- **Practice address fax:** (714) 509-8374
- **Mailing address:** 1201 W LA VETA AVE, ORANGE, CA 92868-4203
- **Mailing address phone:** (714) 509-8649
- **Mailing address fax:** (714) 509-8374

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | CA | — |
| 103TC0700X | Clinical Psychologist | — | CA | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | CA | — |
| 202C00000X | Independent Medical Examiner Physician | — | CA | — |
| 208000000X | Pediatrics Physician | — | CA | — |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | — | CA | Yes |
| 2084P0800X | Psychiatry Physician | — | CA | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | CA | — |

## Other

- **Enumeration date:** 03/17/2015
- **Last updated:** 03/23/2015