Healthcare Provider Details

I. General information

NPI: 1558531780
Provider Name (Legal Business Name): ORTHOPEDIC CARE CENTER OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S. FAIRMOUNT STREET SUITE 410
PASADENA CA
91105
US

IV. Provider business mailing address

17525 VENTURA BLVD SUITE 200
ENCINO CA
91316-3843
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-1787
  • Fax: 626-796-1787
Mailing address:
  • Phone: 818-995-8590
  • Fax: 818-285-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. ARI RESNIK
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-995-8590