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General NPI Number Information
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NPI Number | 1043607823
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Entity Type | Organization
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Legal Business Name | ORTHO SURG CARE, INC.
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 9401 HAVEN AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5335
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Country | US
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Telephone | 855-862-2855
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Fax |
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Provider Business Mailing Address
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Address Line | 12223 HIGHLAND AVE SUITE 106-442
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-2574
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Country | US
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Telephone | 855-862-2855
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ANASTASIA SOMOVA
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Credential |
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Telephone | 855-862-2855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 75305
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License Number State | CA
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