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Organization
SPINE AND SPORTS SPECIALITIES MEDICAL GROUP
Active
Organization
SPINE AND SPORTS SPECIALITIES MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CORINNE WALKER (CHIEF OPERATING OFFICER)
(714) 598-1745
Entity
Organization
Contact information
Practice address
1120 W. LA VETA AVENUE, SUITE 300, ORANGE, CA 92868-4233
(714) 598-1745
(714) 941-9539
Mailing address
1120 W LA VETA AVE STE 300, ORANGE, CA 92868-4246
(714) 598-1745
(714) 941-9539
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
CA
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
NULL
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
—
NULL
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
NULL
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
NULL
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
NULL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
NULL
208VP0014X
Interventional Pain Medicine Physician
—
—
261QR0200X
Radiology Clinic/Center
—
NULL
261QU0200X
Urgent Care Clinic/Center
—
NULL
Other
Enumeration date
01/13/2015
Last updated
11/01/2024
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