Organization
DR. PATRICIA'S HEALTH CLUB, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES POTTER STIVERS (CHIEF FINANCIAL OFFICER)
(949) 226-1733
Entity
Organization
Contact information
Practice address
1310 W. STEWART DRIVE, SUITE 508, ORANGE, CA 92868-3856
(714) 549-6440
(714) 549-6449
Mailing address
211 E. COLUMBINE, UNIT D, SANTA ANA, CA 92707-4404
(714) 549-6440
(714) 549-6449
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
252Y00000X
Early Intervention Provider Agency
A72318
CA
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
03/12/2011
Last updated
03/01/2024
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