Healthcare Provider Details

I. General information

NPI: 1346420403
Provider Name (Legal Business Name): RISSER ORTHOPAEDIC GROUP, A MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 12/20/2007
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 TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE CONLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 626-797-2002