Healthcare Provider Details

I. General information

NPI: 1710305602
Provider Name (Legal Business Name): CENTER FOR ADVANCED ORTHOPEDICS AND SPORTS MEDICINE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 BROOKHURST ST STE 2600
FOUNTAIN VALLEY CA
92708-6728
US

IV. Provider business mailing address

30025 ALICIA PKWY STE 157
LAGUNA NIGUEL CA
92677-2090
US

V. Phone/Fax

Practice location:
  • Phone: 714-200-1010
  • Fax: 714-200-1299
Mailing address:
  • Phone: 949-493-0616
  • Fax: 949-493-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA86043
License Number StateCA

VIII. Authorized Official

Name: MR. RAMY N. ELIAS
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 714-641-2640