# SPORTS AND SPINE ORTHOPAEDICS

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

## Provider details

- **NPI number:** 1811936743
- **Authorized official:** MRS. NORA MIES (PATIENT ACCOUNT REP)
- **Authorized official phone:** (310) 375-8700

## Contact information

- **Practice address:** 23456 HAWTHORNE BLVD, SUITE 200 BUILDING 5, TORRANCE, CA 90505-4716
- **Practice address phone:** (310) 375-8700
- **Mailing address:** 23456 HAWTHORNE BLVD, SUITE 200 BUILDING 5, TORRANCE, CA 90505-4716
- **Mailing address phone:** (310) 375-8700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | A62201 | CA | Yes |

## Other

- **Enumeration date:** 06/06/2006
- **Last updated:** 01/28/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 601860000 | DOL | CA |
| 01 | — | 6332760001 | NATIONAL SUPPLIER CLEARINGHOUSE | CA |