1215476312 NPI number — SPECIALIZED ORTHOPEDIC SOLUTIONS INC

Table of content: (NPI 1215476312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215476312 NPI number — SPECIALIZED ORTHOPEDIC SOLUTIONS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALIZED ORTHOPEDIC SOLUTIONS INC
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:
6
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:
1215476312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14431 VENTURA BLVD
Provider Second Line Business Mailing Address:
SUITE 290
Provider Business Mailing Address City Name:
SHERMAN OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91423-2606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-280-3147
Provider Business Mailing Address Fax Number:
323-978-2479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9259 ETON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATSWORTH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91311-5808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-280-3147
Provider Business Practice Location Address Fax Number:
323-978-2479
Provider Enumeration Date:
02/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
VONDERHAAR
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
818-280-3147

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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