Healthcare Provider Details

I. General information

NPI: 1982765798
Provider Name (Legal Business Name): ASF ORTHOPAEDIC MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 EAST 17TH STREET SUITE W130
SANTA ANA CA
92701-2228
US

IV. Provider business mailing address

PO BOX 3459
CHATSWORTH CA
91313-3459
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-8519
  • Fax: 714-972-0277
Mailing address:
  • Phone: 818-700-1250
  • Fax: 818-700-1045

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: ALLEN S FONSECA
Title or Position: OWNER
Credential: MD
Phone: 714-972-8519