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NPI Code Detail

MEDICARE: ORTHOPEDIC MEDICAL CENTER

MEDICARE: ORTHOPEDIC MEDICAL CENTER
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
1332900000XNon-Pharmacy Dispensing SiteAF8799681CA

General Provider Information

NPI Number : 1942475777
Entity Type Code : Organization
Provider Name (Legal Business Name) : ORTHOPEDIC MEDICAL CENTER
Provider Business Mailing Address
First Line : 3607 OLD CONEJO RD
Second Line :
City : THOUSAND OAKS
State : CA
Zip : 91320-2123
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18039 SHERMAN WAY
Second Line : NORTH SUITE
City : RESEDA
State : CA
Zip : 91335-4630
Country : US
Telephone Number : 818-708-8100
Fax Number :
Authorized Official
Title or Position : CEO
Name : DESTRY SETSER
Credential :
Telephone Number : 805-214-0915
Provider Enumeration Date : 04/23/2008
Last Update Date : 04/23/2008

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Directions to “ORTHOPEDIC MEDICAL CENTER ” Practice Location

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