Organization
PROVIDENCE - CARDIOLOGY
Active
Other names
Pediatric Subspecialty Faculty, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH M FARACE (MANAGER)
(714) 516-4295
Entity
Organization
Contact information
Practice address
1310 W STEWART DR STE 212, ORANGE, CA 92868-3837
(714) 516-4295
Mailing address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 516-4295
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR009039B
—
CA
05
—
GR009039D
—
CA
05
—
GR009039G
—
CA
Enumeration date
08/07/2007
Last updated
02/25/2008
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