Healthcare Provider Details

I. General information

NPI: 1417558404
Provider Name (Legal Business Name): ORTHOWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N EUCLID ST STE 201
ANAHEIM CA
92801-4122
US

IV. Provider business mailing address

PO BOX 45928
BALTIMORE MD
21297-5928
US

V. Phone/Fax

Practice location:
  • Phone: 714-241-7000
  • Fax: 714-241-7003
Mailing address:
  • Phone: 714-241-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BRYCE ALAN JOHNSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 949-586-3200