1366643082 NPI number — ORANGE COAST ORTHOPEDIC & SPORTS MEDICINE GROUP

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 1366643082 NPI number — ORANGE COAST ORTHOPEDIC & SPORTS MEDICINE GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORANGE COAST ORTHOPEDIC & SPORTS MEDICINE GROUP
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:
SOUTH COAST PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1366643082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 HEMLOCK WAY
Provider Second Line Business Mailing Address:
STE 205
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92707-3650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-755-7006
Provider Business Mailing Address Fax Number:
714-545-2762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 HEMLOCK WAY
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92707-3650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-755-7006
Provider Business Practice Location Address Fax Number:
714-545-2762
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROTTERMANN
Authorized Official First Name:
ISRAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
714-755-7006

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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