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General NPI Number Information
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NPI Number | 1831361245
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Entity Type | Organization
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Legal Business Name | WESTERN ORTHOPEDIC MEDICAL CENTER
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 5900 PACIFIC BLVD SUITE 202-A
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-2914
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Country | US
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Telephone | 323-278-1135
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Fax | 323-278-9319
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Provider Business Mailing Address
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Address Line | 5900 PACIFIC BLVD SUITE 202-A
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-2914
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Country | US
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Telephone | 323-278-1135
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Fax | 323-278-9319
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Authorized Official
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Title or Position | OWNER
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Name | OCTAVIO DIAZ-LIZARRAGA
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Credential | M.D.
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Telephone | 323-278-1135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A-26388
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License Number State | CA
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