Healthcare Provider Details

I. General information

NPI: 1578985123
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA ORTHOPEDIC INSTITUTE, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CONGRESS ST STE 201
PASADENA CA
91105-3021
US

IV. Provider business mailing address

39 CONGRESS ST STE 201
PASADENA CA
91105-3021
US

V. Phone/Fax

Practice location:
  • Phone: 626-585-2948
  • Fax: 818-901-6636
Mailing address:
  • Phone: 626-585-2948
  • Fax: 818-901-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TODD D. MOLDAWER
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 818-901-6600