1144632753 NPI number — SOUTHERN CALIFORNIA ORTHOPEDIC INSTITUTE, LP

Table of content: (NPI 1144632753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144632753 NPI number — SOUTHERN CALIFORNIA ORTHOPEDIC INSTITUTE, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN CALIFORNIA ORTHOPEDIC INSTITUTE, LP
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:
1144632753
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6815 NOBLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91405-3796
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-901-6600
Provider Business Mailing Address Fax Number:
818-997-7826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19950 RINALDI ST # 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTER RANCH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91326-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-901-6600
Provider Business Practice Location Address Fax Number:
818-997-7826
Provider Enumeration Date:
05/30/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MOLDAWER
Authorized Official First Name:
TODD
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
818-901-6600

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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