Healthcare Provider Details

I. General information

NPI: 1952624595
Provider Name (Legal Business Name): ORTHOPEDIC MEDICAL CENTER2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18039 SHERMAN WAY
RESEDA CA
91335-4630
US

IV. Provider business mailing address

18039 SHERMAN WAY
RESEDA CA
91335-4630
US

V. Phone/Fax

Practice location:
  • Phone: 818-708-8100
  • Fax: 818-996-7008
Mailing address:
  • Phone: 818-708-8100
  • Fax: 818-996-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberA30198
License Number StateCA

VIII. Authorized Official

Name: MRS. ROSEMARY FRANKE
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-708-8100