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General NPI Number Information
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NPI Number | 1669067963
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Entity Type | Organization
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Legal Business Name | SOUTHLAND ORTHO SOLUTIONS, LLC
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 23362 PERALTA DR STE 2
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1711
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Country | US
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Telephone | 949-328-9622
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Fax |
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Provider Business Mailing Address
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Address Line | 27702 CROWN VALLEY PARKWAY SUITE D-4 #230
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City | LADERA RANCH
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State | CA
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Zip | 92694
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Country | US
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Telephone | 949-433-5115
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MR. FRED FORTUN
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Credential |
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Telephone | 949-433-5115
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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 |
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License Number State |
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