Organization
THE SPORTS CLINIC ORTHOPAEDIC MEDICAL ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WESLEY MERRILL NOTTAGE M.D. (PRESIDENT)
(949) 581-7001
Entity
Organization
Contact information
Practice address
23961 CALLE DE LA MAGDALENA, STE 229, LAGUNA HILLS, CA 92653-3616
(949) 581-7001
(949) 581-8410
Mailing address
23961 CALLE DE LA MAGDALENA, STE 229, LAGUNA HILLS, CA 92653-3616
(949) 581-7001
(949) 581-8410
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G29856
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ38138Z
BLUE SHIELD GRP #
CA
Enumeration date
12/11/2006
Last updated
11/06/2009
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