# THE SPORTS CLINIC ORTHOPAEDIC MEDICAL ASSOCIATES, INC.

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

## Provider details

- **NPI number:** 1376603183
- **Authorized official:** DR. WESLEY MERRILL NOTTAGE M.D. (PRESIDENT)
- **Authorized official phone:** (949) 581-7001

## Contact information

- **Practice address:** 23961 CALLE DE LA MAGDALENA, STE 229, LAGUNA HILLS, CA 92653-3616
- **Practice address phone:** (949) 581-7001
- **Practice address fax:** (949) 581-8410
- **Mailing address:** 23961 CALLE DE LA MAGDALENA, STE 229, LAGUNA HILLS, CA 92653-3616
- **Mailing address phone:** (949) 581-7001
- **Mailing address fax:** (949) 581-8410

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | G29856 | CA | Yes |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 11/06/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | ZZZ38138Z | BLUE SHIELD GRP \# | CA |