Organization
PURI ORTHOPEDIC CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEATA MOORE (BILLING MANAGER)
(760) 243-0464
Entity
Organization
Contact information
Practice address
12830 HESPERIA ROAD, SUITE A, VICTORVILLE, CA 92395-7788
(760) 243-7715
(760) 243-5442
Mailing address
12830 HESPERIA ROAD, SUITE A, VICTORVILLE, CA 92395-7788
(760) 243-7715
(760) 243-5442
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C500750
—
CA
Enumeration date
07/13/2006
Last updated
02/20/2014
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