Organization
GUSTAFSON ORTHOPEDICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMI ZIOLA (MEDICAL BILLER)
(909) 478-5600
Entity
Organization
Contact information
Practice address
10459 MT VIEW AVE, STE. B, LOMA LINDA, CA 92354-2033
(909) 478-5600
(909) 478-5601
Mailing address
PO BOX 1056, LOMA LINDA, CA 92354-1056
(909) 478-5600
(909) 478-5601
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G24086
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G240860
—
CA
01
—
ZZZ28798Z
MEDICARE PROVIDER #
CA
Enumeration date
12/06/2007
Last updated
02/11/2008
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