NPIMap

Organization Active NPI

Orange Coast Fyzical

  • Physical Medicine & Rehabilitation Physician
  • Laguna Woods, CA
National Provider Identifier
1215434790
Registry record updated Apr 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
ORANGE COAST FYZICAL
Practice address
24361 El Toro Rd Ste 140
Laguna Woods, CA 92637-8898
Phone
(949) 715-0500
NPI assigned
Apr 10, 2018
Organization subpart
Yes
Parent organization
ORANGE COAST HEAD AND NECK SURGERYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 10, 2018

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

Authorized official

Name
Dr. Robert Pettis, MDNPI 1427082346
Title
Co-Owner
Phone
(949) 715-0500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X CA Primary

Addresses

Primary practice location

24361 El Toro Rd Ste 140
Laguna Woods, CA 92637-8898

Mailing address

PO Box 53970
Irvine, CA 92619-3970
Phone (949) 715-0500

National Provider Directory

National Provider Directory
Part of
Orange Coast Head and Neck

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523318400000",
    "number": "1215434790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 53970",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926193970",
            "telephone_number": "949-715-0500",
            "fax_number": "949-715-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24361 EL TORO RD STE 140",
            "city": "LAGUNA WOODS",
            "state": "CA",
            "postal_code": "926378898",
            "telephone_number": "949-715-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORANGE COAST FYZICAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ORANGE COAST HEAD AND NECK SURGERY",
        "enumeration_date": "2018-04-10",
        "last_updated": "2018-04-10",
        "status": "A",
        "authorized_official_last_name": "PETTIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "949-715-0500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Woods, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2018; 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.