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General NPI Number Information
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NPI Number | 1437380441
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Entity Type | Organization
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Legal Business Name | ACTIVE ORTHOPEDIC MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/07/2009
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 1051 E TUOLUMNE RD 103
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City | TURLOCK
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State | CA
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Zip | 95382-1546
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Country | US
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Telephone | 209-216-5900
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Fax | 209-216-5909
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Provider Business Mailing Address
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Address Line | PO BOX 2120
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City | TURLOCK
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State | CA
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Zip | 95381-2120
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Country | US
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Telephone | 209-216-5900
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Fax | 209-216-5909
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICK GUERRERO
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Credential | DO
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Telephone | 209-216-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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