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
5525 W SLAUSON AVE, LOS ANGELES, CA 90056
(310) 642-0325
(310) 642-0338
Mailing address
5525 W SLAUSON AVE, LOS ANGELES, CA 90056-1047
(310) 642-0325
(310) 642-0338
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HSC32032G
—
CA
Enumeration date
05/15/2007
Last updated
07/19/2018
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