Healthcare Provider Details

I. General information

NPI: 1568453967
Provider Name (Legal Business Name): WEST COAST ORTHOPAEDIC MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HUNTINGTON DR SUITE 408
ARCADIA CA
91007-3462
US

IV. Provider business mailing address

301 W HUNTINGTON DR SUITE 408
ARCADIA CA
91007-3462
US

V. Phone/Fax

Practice location:
  • Phone: 626-821-0707
  • Fax: 626-821-0239
Mailing address:
  • Phone: 626-821-0707
  • Fax: 626-821-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY M. MOSCARELLO
Title or Position: PHYSICIAN/PRESIDENT
Credential: M.D.
Phone: 626-821-0707