Healthcare Provider Details

I. General information

NPI: 1508823873
Provider Name (Legal Business Name): COMMUNITY ORTHOPEDIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26401 CROWN VALLEY PKWY SUITE 101
MISSION VIEJO CA
92691-6350
US

IV. Provider business mailing address

26401 CROWN VALLEY PKWY SUITE 101
MISSION VIEJO CA
92691-6350
US

V. Phone/Fax

Practice location:
  • Phone: 949-348-4000
  • Fax:
Mailing address:
  • Phone: 949-348-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG42640
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG63599
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG69562
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG64377
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberG74361
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG25458
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA70607
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberA108023
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA64745
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA80044
License Number StateCA

VIII. Authorized Official

Name: JERALD P WALDMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 949-348-4000