Healthcare Provider Details

I. General information

NPI: 1629382031
Provider Name (Legal Business Name): CALIFORNIA ORTHOPEDICS AND SPORTS MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17525 VENTURA BLVD STE 203
ENCINO CA
91316-5109
US

IV. Provider business mailing address

17525 VENTURA BLVD STE 203
ENCINO CA
91316-5109
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-0200
  • Fax: 818-638-5762
Mailing address:
  • Phone: 818-986-0200
  • Fax: 818-638-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA111645
License Number StateCA

VIII. Authorized Official

Name: LINDA ENGLAND
Title or Position: CEO
Credential:
Phone: 818-986-0200