Healthcare Provider Details

I. General information

NPI: 1659477487
Provider Name (Legal Business Name): RISSER ORTHOPAEDIC GROUP, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 E WASHINGTON BLVD
PASADENA CA
91107-1412
US

IV. Provider business mailing address

2627 E WASHINGTON BLVD
PASADENA CA
91107-1412
US

V. Phone/Fax

Practice location:
  • Phone: 626-797-2002
  • Fax: 626-798-0567
Mailing address:
  • Phone: 626-797-2002
  • Fax: 626-798-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. DONALD J NORQUIST
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-797-2002