Organization
PSF NEUROLOGY 2
Active
Other names
Pediatric Subspecialty Faculty
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH FARACE (BILLING MANAGER)
(714) 416-4295
Entity
Organization
Contact information
Practice address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 516-4295
Mailing address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 516-4295
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR009039E
—
CA
Enumeration date
05/28/2008
Last updated
05/28/2008
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