Healthcare Provider Details

I. General information

NPI: 1174710107
Provider Name (Legal Business Name): ORTHOPAEDIC SPECIALTIES ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 TALBERT AVE
FOUNTAIN VALLEY CA
92708-5153
US

IV. Provider business mailing address

4201 TORRANCE BLVD SUITE190
TORRANCE CA
90503-4504
US

V. Phone/Fax

Practice location:
  • Phone: 310-543-2521
  • Fax: 310-543-9352
Mailing address:
  • Phone: 310-543-2521
  • Fax: 310-543-9352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MELANIE A MCCRACKEN
Title or Position: ADMINISTRATOR
Credential: CPC
Phone: 310-543-2521