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
1940 EL CAJON BLVD, SAN DIEGO, CA 92104
(619) 543-4500
(619) 294-2979
Mailing address
1940 EL CAJON BLVD, SAN DIEGO, CA 92104-1005
(619) 543-4500
(619) 294-2979
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
052035
BLUE CROSS
CA
05
—
ZZT30220I
—
CA
01
—
ZZT40220I
HEALTH NET
CA
Enumeration date
08/20/2009
Last updated
07/19/2018
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