MEDICARE: OCCUPATIONAL ORTHOPEDIC MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0100X	Occupational Medicine Clinic/Center
2	2083X0100X	Occupational Medicine Physician

General Provider Information

NPI Number	:	1609994037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL ORTHOPEDIC MEDICAL GROUP

Provider Business Mailing Address
First Line	:	31938 TEMECULA PKWY # A337
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92592-6810
Country	:	US
Telephone Number	:	714-414-3065
Fax Number	:

Provider Business Practice Location Address
First Line	:	82013 DOCTOR CARREON BLVD STE G
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-5832
Country	:	US
Telephone Number	:	760-775-9500
Fax Number	:	760-775-9567

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID SCOTT JOHNSON
Credential	:	MD
Telephone Number	:	702-283-0085

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	09/15/2022

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