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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
550 N MONTEREY AVE, ONTARIO, CA 91764
(909) 391-0333
(909) 391-2892
Mailing address
550 N MONTEREY AVE, ONTARIO, CA 91764-3318
(909) 391-0333
(909) 391-2892

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
HSP30041K
CA
01
ZZZ94036Z
BLUE CROSS
CA
Enumeration date
08/20/2009
Last updated
07/19/2018
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