NPIMap

Organization Active NPI

Providence - Cardiology

  • Pediatric Cardiology Physician
  • Orange, CA
National Provider Identifier
1043401870
Registry record updated Feb 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
Legal business name
PROVIDENCE - CARDIOLOGY
Practice address
1310 W Stewart Dr Ste 212
Orange, CA 92868-3837
Phone
(714) 516-4295
NPI assigned
Aug 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Elizabeth M Farace
Title
Manager
Phone
(714) 516-4295

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0202X CA Primary

Addresses

Primary practice location

1310 W Stewart Dr Ste 212
Orange, CA 92868-3837

Mailing address

455 S Main St
Orange, CA 92868-3835
Phone (714) 516-4295

Other identifiers 3

IdentifierTypeStateIssuer
GR009039GMedicaidCA
GR009039DMedicaidCA
GR009039BMedicaidCA

Other names 1

  • Pediatric Subspecialty Faculty, Inc. Other name

National Provider Directory

National Provider Directory
Tax ID family
PSF Neurology 234 organizations share this tax ID, including this one

Other organizations with this tax ID 33

Organizations that report the same tax identification number in the National Provider Directory.

View all 33

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203897600000",
    "number": "1043401870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 S MAIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683835",
            "telephone_number": "714-516-4295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 W STEWART DR STE 212",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683837",
            "telephone_number": "714-516-4295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE - CARDIOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-07",
        "last_updated": "2008-02-25",
        "status": "A",
        "authorized_official_last_name": "FARACE",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "714-516-4295"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR009039G",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR009039D",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR009039B",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Subspecialty Faculty, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.