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Organization
WEST COAST ORTHOPAEDIC MEDICAL GROUP, INC
Active
Organization
WEST COAST ORTHOPAEDIC MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY M. MOSCARELLO M.D. (PHYSICIAN/PRESIDENT)
(626) 821-0707
Entity
Organization
Contact information
Practice address
301 W HUNTINGTON DR, SUITE 408, ARCADIA, CA 91007-3462
(626) 821-0707
(626) 821-0239
Mailing address
301 W HUNTINGTON DR, SUITE 408, ARCADIA, CA 91007-3462
(626) 821-0707
(626) 821-0239
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568453967
—
CA
01
—
ZZZ577232
BLUE SHIELD
—
Enumeration date
11/03/2005
Last updated
05/13/2009
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