1336228832 NPI number — ORTHOPAEDIC SPECIALTY INSTITUTE MEDICAL GROUP OF ORANGE COUNTY

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 1336228832 NPI number — ORTHOPAEDIC SPECIALTY INSTITUTE MEDICAL GROUP OF ORANGE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC SPECIALTY INSTITUTE MEDICAL GROUP OF ORANGE COUNTY
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:
1336228832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
363 S MAIN ST STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-3816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-634-4567
Provider Business Mailing Address Fax Number:
714-634-4569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
363 S MAIN ST STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-634-4567
Provider Business Practice Location Address Fax Number:
714-634-4569
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEXTER
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACTING LIAISON
Authorized Official Telephone Number:
714-937-2155

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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