Healthcare Provider Details

I. General information

NPI: 1245428069
Provider Name (Legal Business Name): ORTHOPAEDIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14375 PIPELINE AVE
CHINO CA
91710
US

IV. Provider business mailing address

PO BOX 490
DAN DIMAS CA
91773
US

V. Phone/Fax

Practice location:
  • Phone: 909-517-3884
  • Fax: 909-517-3646
Mailing address:
  • Phone: 909-971-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS O BRYAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-918-6655