# ORANGE COAST FYZICAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ORANGE COAST HEAD AND NECK SURGERY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1215434790
- **Legal business name:** ORANGE COAST HEAD AND NECK SURGERY
- **Authorized official:** DR. ROBERT PETTIS MD (CO-OWNER)
- **Authorized official phone:** (949) 715-0500

## Contact information

- **Practice address:** 24361 EL TORO RD STE 140, LAGUNA WOODS, CA 92637-8898
- **Practice address phone:** (949) 715-0500
- **Mailing address:** PO BOX 53970, IRVINE, CA 92619-3970
- **Mailing address phone:** (949) 715-0500
- **Mailing address fax:** (949) 715-0504

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | CA | Yes |

## Other

- **Enumeration date:** 04/10/2018
- **Last updated:** 04/10/2018