Healthcare Provider Details

I. General information

NPI: 1417571787
Provider Name (Legal Business Name): FRISANCHO MEHTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23600 TELO AVE STE 180
TORRANCE CA
90505-4039
US

IV. Provider business mailing address

23600 TELO AVE STE 180
TORRANCE CA
90505-4039
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-1500
  • Fax: 310-257-1508
Mailing address:
  • Phone: 310-257-1500
  • Fax: 310-257-1508

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: JUAN CARLOS FRISANCHO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 310-257-1500