Organization
ORANGE COAST FYZICAL
Active
Organization
ORANGE COAST FYZICAL
Active
Parent organization
ORANGE COAST HEAD AND NECK SURGERY
Organization subpart
Yes
Provider details
NPI number
Legal business name
ORANGE COAST HEAD AND NECK SURGERY
Authorized official
DR. ROBERT PETTIS MD (CO-OWNER)
(949) 715-0500
Entity
Organization
Contact information
Practice address
24361 EL TORO RD STE 140, LAGUNA WOODS, CA 92637-8898
(949) 715-0500
Mailing address
PO BOX 53970, IRVINE, CA 92619-3970
(949) 715-0500
(949) 715-0504
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
CA
Other
Enumeration date
04/10/2018
Last updated
04/10/2018
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