MEDICARE: SOUTH COUNTY ORTHOPEDIC SPECIALISTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CN9515	OTHER	CA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	GR0064200	OTHER	CA	CAL-OPTIMA

General Provider Information

NPI Number	:	1053314625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COUNTY ORTHOPEDIC SPECIALISTS

Provider Business Mailing Address
First Line	:	PO BOX 31063
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92654-1063
Country	:	US
Telephone Number	:	949-586-3200
Fax Number	:	949-900-2136

Provider Business Practice Location Address
First Line	:	24331 EL TORO RD
Second Line	:	STE 200
City	:	LAGUNA WOODS
State	:	CA
Zip	:	92637-2753
Country	:	US
Telephone Number	:	949-586-3200
Fax Number	:	949-900-2136

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. LARRY M GERSTEN
Credential	:	M.D.
Telephone Number	:	949-586-3200

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	01/11/2008

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Directions to “SOUTH COUNTY ORTHOPEDIC SPECIALISTS ” Practice Location

Language	Start Address	Practice Location

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