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General NPI Number Information
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NPI Number | 1881874998
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Entity Type | Organization
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Legal Business Name | OPTIMAL ORTHOPEDIC MEDICAL GROUP
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 17400 IRVINE BLVD STE L
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City | TUSTIN
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State | CA
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Zip | 92780-3030
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Country | US
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Telephone | 714-434-8663
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1309
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City | NEWPORT BEACH
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State | CA
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Zip | 92659-0109
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Country | US
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Telephone | 714-434-8663
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JESSICA ROGER
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Credential |
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Telephone | 714-434-8663
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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 | G53516
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License Number State | CA
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