MEDICARE: SKYLAR ORTHOPEDICS A MEDICAL CORPORATION

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	G083591	CA

General Provider Information

NPI Number	:	1841557691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYLAR ORTHOPEDICS A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	302 W LA VETA AVE
Second Line	:	SUITE 100
City	:	ORANGE
State	:	CA
Zip	:	92866-2607
Country	:	US
Telephone Number	:	714-769-8400
Fax Number	:	714-769-8381

Provider Business Practice Location Address
First Line	:	302 W LA VETA AVE
Second Line	:	SUITE 100
City	:	ORANGE
State	:	CA
Zip	:	92866-2607
Country	:	US
Telephone Number	:	714-769-8400
Fax Number	:	714-769-8381

Authorized Official
Title or Position	:	MANAGEMENT
Name	:	MRS. PENNIE LEANN TELARROJA
Credential	:
Telephone Number	:	909-447-4787

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	04/18/2012

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