Healthcare Provider Details

I. General information

NPI: 1427369495
Provider Name (Legal Business Name): ORTHOPEDIC MEDICAL CENTER2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S WESTLAKE BLVD 237
WESTLAKE VILLAGE CA
91361-1929
US

IV. Provider business mailing address

1240 S WESTLAKE BLVD 237
WESTLAKE VILLAGE CA
91361-1929
US

V. Phone/Fax

Practice location:
  • Phone: 818-708-8100
  • Fax: 818-705-8818
Mailing address:
  • Phone: 818-708-8100
  • Fax: 818-705-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MISS ROSEMARY FRANKE
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-708-8100