Healthcare Provider Details

I. General information

NPI: 1326178245
Provider Name (Legal Business Name): MAMMOTH LAKES ORTHOPEDICS ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 OLD MAMMOTH ROAD SUITE R
MAMMOTH LAKES CA
93546-5021
US

IV. Provider business mailing address

23600 TELO AVE SUITE #180
TORRANCE CA
90505-4035
US

V. Phone/Fax

Practice location:
  • Phone: 310-924-8688
  • Fax: 760-924-8688
Mailing address:
  • Phone: 310-257-1500
  • Fax: 310-257-1506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG075766
License Number StateCA

VIII. Authorized Official

Name: DR. DONALD BRIAN STRIPLIN
Title or Position: CEO
Credential: M.D.
Phone: 310-508-7638