Healthcare Provider Details

I. General information

NPI: 1679008528
Provider Name (Legal Business Name): PROFESSIONAL ORTHOPEDICS MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 SILLECT AVE
BAKERSFIELD CA
93308-6340
US

IV. Provider business mailing address

7345 MEDICAL CENTER DR SUITE 280
WEST HILLS CA
91307-1910
US

V. Phone/Fax

Practice location:
  • Phone: 661-381-7222
  • Fax: 661-846-2447
Mailing address:
  • Phone: 818-888-2855
  • Fax: 818-888-0702

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: FREDERICK LI
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-888-2855