# SOUTHERN CALIFORNIA ORTHOPEDIC MEDICAL GROUP INC

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

## Provider details

- **NPI number:** 1407082159
- **Authorized official:** ANDREW J MILES DC (OWNER)
- **Authorized official phone:** (909) 941-3986

## Contact information

- **Practice address:** 3602 INLAND EMPIRE BLVD, SUITE B 120, ONTARIO, CA 91764-4900
- **Practice address phone:** (909) 941-3986
- **Practice address fax:** (909) 941-3988
- **Mailing address:** 3602 INLAND EMPIRE BLVD, SUITE B 120, ONTARIO, CA 91764-4900
- **Mailing address phone:** (909) 941-3986
- **Mailing address fax:** (909) 941-3988

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 171100000X | Acupuncturist | — | NULL | — |
| 171100000X | Acupuncturist | — | — | — |
| 174400000X | Specialist | — | NULL | — |
| 174400000X | Specialist | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XS0114X | Adult Reconstructive Orthopaedic Surgery Physician | — | NULL | — |
| 207XS0114X | Adult Reconstructive Orthopaedic Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 06/09/2009
- **Last updated:** 08/31/2016