Healthcare Provider Details

I. General information

NPI: 1255362687
Provider Name (Legal Business Name): PROFESSIONAL ORTHOPEDICS MEDICAL ASSOCIATES A PROF MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 MEDICAL CENTER DR SUITE #280
WEST HILLS CA
91307-1937
US

IV. Provider business mailing address

7345 MEDICAL CENTER DR SUITE #280
WEST HILLS CA
91307-1937
US

V. Phone/Fax

Practice location:
  • Phone: 818-888-2855
  • Fax: 818-888-0702
Mailing address:
  • Phone: 818-888-2855
  • Fax: 818-888-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG065065
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA79561
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3859
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24912
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 16970
License Number StateCA

VIII. Authorized Official

Name: FREDERICK J LI
Title or Position: FRONT OFFICE SUPERVISOR
Credential:
Phone: 818-888-2855