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Organization
THE SPORTS CLINIC ORTHOPAEDIC MEDICAL ASSOCIATES, INC.
Active
Organization
THE SPORTS CLINIC ORTHOPAEDIC MEDICAL ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WESLEY MERRILL NOTTAGE M.D. (PRESIDENT)
(949) 581-7001
Entity
Organization
Contact information
Practice address
23961 CALLE DE LA MAGDALENA, STE 229, LAGUNA HILLS, CA 92653-3616
(949) 581-7001
(949) 581-8410
Mailing address
23961 CALLE DE LA MAGDALENA, STE 229, LAGUNA HILLS, CA 92653-3616
(949) 581-7001
(949) 581-8410
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G29856
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ38138Z
BLUE SHIELD GRP #
CA
Enumeration date
12/11/2006
Last updated
11/06/2009
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