Basic Information
| Provider Information | |||||||||
| NPI: | 1669541330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HELGESEN | ||||||||
| FirstName: | HELGE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 S MAIN ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146344567 | ||||||||
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| Practice Location | |||||||||
| Address1: | 280 S MAIN ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146344567 | ||||||||
| FaxNumber: | 7146344569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA20770 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | PA20770 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA20770 | 01 | CA | LIC NUMBER | OTHER |