MEDICARE: CORONA ORTHOPAEDIC ASSOCIATES MEDICAL GROUP INC

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	207X00000X	Orthopaedic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CI7854	OTHER		RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	ZZZ51830Z	OTHER		BLUE SHIELD OF CALIFORNIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598872657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORONA ORTHOPAEDIC ASSOCIATES MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	341 MAGNOLIA AVENUE
Second Line	:	SUITE 101
City	:	CORONA
State	:	CA
Zip	:	92879-3331
Country	:	US
Telephone Number	:	951-735-6060
Fax Number	:	951-735-4510

Provider Business Practice Location Address
First Line	:	341 MAGNOLIA AVENUE
Second Line	:	SUITE 101
City	:	CORONA
State	:	CA
Zip	:	92879-3331
Country	:	US
Telephone Number	:	951-735-6060
Fax Number	:	951-735-4510

Authorized Official
Title or Position	:	SECRETARY
Name	:	BRADLEY LLOYD BAUM
Credential	:	MD
Telephone Number	:	951-735-6060

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	02/03/2023

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Directions to “CORONA ORTHOPAEDIC ASSOCIATES MEDICAL GROUP INC ” Practice Location

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