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Organization
THC - ORANGE COUNTY, LLC
Active
Organization
THC - ORANGE COUNTY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOSTAFA ADAM DARVISH (EXECUTIVE DIRECTOR)
(714) 893-4541
Entity
Organization
Contact information
Practice address
550 N MONTEREY AVE, ONTARIO, CA 91764
(909) 391-0333
(909) 391-2892
Mailing address
550 N MONTEREY AVE, ONTARIO, CA 91764-3318
(909) 391-0333
(909) 391-2892
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HSP30041K
—
CA
01
—
ZZZ94036Z
BLUE CROSS
CA
Enumeration date
08/20/2009
Last updated
07/19/2018
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