# WESTERN ORTHOPEDIC MEDICAL CENTER

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

## Provider details

- **NPI number:** 1831361245
- **Authorized official:** OCTAVIO DIAZ-LIZARRAGA M.D. (OWNER)
- **Authorized official phone:** (323) 278-1135

## Contact information

- **Practice address:** 5900 PACIFIC BLVD, SUITE 202-A, HUNTINGTON PARK, CA 90255-2914
- **Practice address phone:** (323) 278-1135
- **Practice address fax:** (323) 278-9319
- **Mailing address:** 5900 PACIFIC BLVD, SUITE 202-A, HUNTINGTON PARK, CA 90255-2914
- **Mailing address phone:** (323) 278-1135
- **Mailing address fax:** (323) 278-9319

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | A-26388 | CA | Yes |

## Other

- **Enumeration date:** 03/25/2008
- **Last updated:** 03/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0080570 | — | CA |
| 01 | — | W6033A | MEDICARE | CA |