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General NPI Number Information
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NPI Number | 1053314625
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Entity Type | Organization
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Legal Business Name | SOUTH COUNTY ORTHOPEDIC SPECIALISTS
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 24331 EL TORO RD STE 200
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City | LAGUNA WOODS
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State | CA
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Zip | 92637-2753
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Country | US
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Telephone | 949-586-3200
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Fax | 949-900-2136
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Provider Business Mailing Address
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Address Line | PO BOX 31063
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City | LAGUNA HILLS
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State | CA
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Zip | 92654-1063
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Country | US
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Telephone | 949-586-3200
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Fax | 949-900-2136
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Authorized Official
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Title or Position | OFFICER
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Name | DR. LARRY M GERSTEN
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Credential | M.D.
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Telephone | 949-586-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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