Healthcare Provider Details

I. General information

NPI: 1144632753
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA ORTHOPEDIC INSTITUTE, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2014
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19950 RINALDI ST # 100
PORTER RANCH CA
91326-4141
US

IV. Provider business mailing address

6815 NOBLE AVE
VAN NUYS CA
91405-3796
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-6600
  • Fax: 818-997-7826
Mailing address:
  • Phone: 818-901-6600
  • Fax: 818-997-7826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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