MEDICARE: PACIFIC ORTHOPEDIC AND REHABILITATION MEDICAL CENTER, INC.

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	209800000X	Legal Medicine (M.D./D.O.) Physician

General Provider Information

NPI Number	:	1699909531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC ORTHOPEDIC AND REHABILITATION MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	5301 WHITTIER BLVD
Second Line	:	4TH FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4038
Country	:	US
Telephone Number	:	323-728-8222
Fax Number	:	323-728-8180

Provider Business Practice Location Address
First Line	:	5301 WHITTIER BLVD
Second Line	:	4TH FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4038
Country	:	US
Telephone Number	:	323-728-8222
Fax Number	:	323-728-8180

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	YURY BRICKMAN
Credential	:
Telephone Number	:	323-728-8222

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	05/06/2009

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