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Organization
SOUTHERN CALIFORNIA SPECIALTY CARE, LLC
Active
Organization
SOUTHERN CALIFORNIA SPECIALTY CARE, 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
1901 COLLEGE AVE, SANTA ANA, CA 92706
(714) 564-7800
(714) 564-7814
Mailing address
1901 COLLEGE AVE, SANTA ANA, CA 92706-2334
(714) 564-7800
(714) 564-7814
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HSP32028F
—
CA
01
—
ZZZD3003Z
BLUE CROSS
CA
Enumeration date
08/20/2009
Last updated
07/23/2018
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