Healthcare Provider Details

I. General information

NPI: 1083667034
Provider Name (Legal Business Name): STERLING B MUTZ MD INC JULIO TALEISNIK MD INC ET AL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE SUITE 860
ORANGE CA
92868
US

IV. Provider business mailing address

1140 W LA VETA AVE SUITE 860
ORANGE CA
92868
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-6500
  • Fax: 714-541-6105
Mailing address:
  • Phone: 714-835-6500
  • Fax: 714-541-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN TERESE SWANSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-835-6500