Healthcare Provider Details

I. General information

NPI: 1043719206
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA ORTHOPEDIC INSTITUTE L.P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 EMPIRE DR STE 120
BAKERSFIELD CA
93309-0408
US

IV. Provider business mailing address

6815 NOBLE AVE
VAN NUYS CA
91405-3796
US

V. Phone/Fax

Practice location:
  • Phone: 805-328-5565
  • Fax: 805-328-5573
Mailing address:
  • Phone: 818-901-6600
  • Fax: 818-997-7826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS GUANCHE
Title or Position: M.D./ ORTHOPEDIC SURGEON
Credential:
Phone: 818-901-6600