Healthcare Provider Details

I. General information

NPI: 1164847547
Provider Name (Legal Business Name): NON-SURGICAL ORTHOPEDIC CENTER A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 S EL CAMINO REAL SUITE 117-122
OCEANSIDE CA
92054-6203
US

IV. Provider business mailing address

2170 S EL CAMINO REAL SUITE 117-122
OCEANSIDE CA
92054-6203
US

V. Phone/Fax

Practice location:
  • Phone: 760-730-8060
  • Fax: 760-730-8061
Mailing address:
  • Phone: 760-730-8060
  • Fax: 760-730-8061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BECKY LOOCK
Title or Position: MANAGER
Credential:
Phone: 760-707-7302