Healthcare Provider Details

I. General information

NPI: 1366643082
Provider Name (Legal Business Name): ORANGE COAST ORTHOPEDIC & SPORTS MEDICINE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 HEMLOCK WAY STE 205
SANTA ANA CA
92707-3650
US

IV. Provider business mailing address

1220 HEMLOCK WAY STE 205
SANTA ANA CA
92707-3650
US

V. Phone/Fax

Practice location:
  • Phone: 714-755-7006
  • Fax: 714-545-2762
Mailing address:
  • Phone: 714-755-7006
  • Fax: 714-545-2762

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: ISRAEL ROTTERMANN
Title or Position: PARTNER
Credential: M.D.
Phone: 714-755-7006