Healthcare Provider Details

I. General information

NPI: 1760109037
Provider Name (Legal Business Name): ORTHOPAEDIC QUALIFIED MEDICAL EVALUATORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13160 MINDANAO WAY STE 310
MARINA DEL REY CA
90292-7907
US

IV. Provider business mailing address

13160 MINDANAO WAY STE 310
MARINA DEL REY CA
90292-7907
US

V. Phone/Fax

Practice location:
  • Phone: 213-947-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRIA HENRY
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 213-947-0000