Healthcare Provider Details

I. General information

NPI: 1336265453
Provider Name (Legal Business Name): JOSEPH C. ANDERSON, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21825 HAWTHORNE BLVD
TORRANCE CA
90503-7003
US

IV. Provider business mailing address

21825 HAWTHORNE BLVD
TORRANCE CA
90503-7003
US

V. Phone/Fax

Practice location:
  • Phone: 310-542-9111
  • Fax: 310-214-5263
Mailing address:
  • Phone: 310-542-9111
  • Fax: 310-214-5263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH CALVIN ANDERSON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 310-542-9111