# DE ANZA ORTHOPEDIC MEDICAL GROUP, INC.

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

## Provider details

- **NPI number:** 1255762340
- **Authorized official:** WADE FAERBER DO (DIRECTOR)
- **Authorized official phone:** (951) 486-5690

## Contact information

- **Practice address:** 26520 CACTUS AVE, MORENO VALLEY, CA 92555
- **Practice address phone:** (951) 486-5690
- **Practice address fax:** (951) 486-5213
- **Mailing address:** PO BOX 7270, MORENO VALLEY, CA 92552-7270

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/27/2013
- **Last updated:** 06/26/2018