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Organization
WESTERN ORTHOPEDIC MEDICAL CENTER
Active
Organization
WESTERN ORTHOPEDIC MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OCTAVIO DIAZ-LIZARRAGA M.D. (OWNER)
(323) 278-1135
Entity
Organization
Contact information
Practice address
5900 PACIFIC BLVD, SUITE 202-A, HUNTINGTON PARK, CA 90255-2914
(323) 278-1135
(323) 278-9319
Mailing address
5900 PACIFIC BLVD, SUITE 202-A, HUNTINGTON PARK, CA 90255-2914
(323) 278-1135
(323) 278-9319
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A-26388
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0080570
—
CA
01
—
W6033A
MEDICARE
CA
Enumeration date
03/25/2008
Last updated
03/25/2008
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