1205176005 NPI number — LOS ANGELES CENTER FOR ORTHOPEDICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205176005 NPI number — LOS ANGELES CENTER FOR ORTHOPEDICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS ANGELES CENTER FOR ORTHOPEDICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205176005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
880 S ATLANTIC BLVD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
MONTEREY PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91754-4700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-588-1993
Provider Business Mailing Address Fax Number:
626-308-2083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 S ATLANTIC BLVD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
MONTEREY PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91754-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-588-1993
Provider Business Practice Location Address Fax Number:
626-308-2083
Provider Enumeration Date:
02/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ONTIVEROS
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
626-588-1993

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  37089 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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