# PROFESSIONAL ORTHOPEDICS MEDICAL ASSOCIATES A PROF MEDICAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255362687
- **Authorized official:** FREDERICK J LI (FRONT OFFICE SUPERVISOR)
- **Authorized official phone:** (818) 888-2855

## Contact information

- **Practice address:** 7345 MEDICAL CENTER DR, SUITE \#280, WEST HILLS, CA 91307-1937
- **Practice address phone:** (818) 888-2855
- **Practice address fax:** (818) 888-0702
- **Mailing address:** 7345 MEDICAL CENTER DR, SUITE \#280, WEST HILLS, CA 91307-1937
- **Mailing address phone:** (818) 888-2855
- **Mailing address fax:** (818) 888-0702

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | A79561 | CA | — |
| 207X00000X | Orthopaedic Surgery Physician | G065065 | CA | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | E3859 | CA | — |
| 225100000X | Physical Therapist | PT24912 | CA | — |
| 363A00000X | Physician Assistant | PA 16970 | CA | — |

## Other

- **Enumeration date:** 07/05/2006
- **Last updated:** 05/11/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | ZZZ53604Z22 | BS GROUP | — |