NPIMap

Organization Active NPI

Southern California Specialty Care, LLC

  • General Practice Physician
  • Santa Ana, CA
National Provider Identifier
1780816934
Registry record updated Jul 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
SOUTHERN CALIFORNIA SPECIALTY CARE, LLC
Practice address
1901 College Ave
Santa Ana, CA 92706
Phone
(714) 564-7800
Fax
(714) 564-7814
NPI assigned
Aug 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2018

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

Authorized official

Name
Mr. Mostafa Adam Darvish
Title
Executive Director
Phone
(714) 893-4541

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

1901 College Ave
Santa Ana, CA 92706

Mailing address

1901 College Ave
Santa Ana, CA 92706-2334
Phone (714) 564-7800

Other identifiers 2

IdentifierTypeStateIssuer
ZZZD3003ZOtherCABLUE CROSS
HSP32028FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Southern California Specialty Care Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532304000000",
    "number": "1780816934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 COLLEGE AVE",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927062334",
            "telephone_number": "714-564-7800",
            "fax_number": "714-564-7814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 COLLEGE AVE",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92706",
            "telephone_number": "714-564-7800",
            "fax_number": "714-564-7814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA SPECIALTY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-20",
        "last_updated": "2018-07-23",
        "status": "A",
        "authorized_official_last_name": "DARVISH",
        "authorized_official_first_name": "MOSTAFA",
        "authorized_official_middle_name": "ADAM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "714-893-4541",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "ZZZD3003Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP32028F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.