Organization
COMMUNITY ORTHOPEDIC MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERALD P WALDMAN MD (PRESIDENT)
(949) 348-4000
Entity
Organization
Contact information
Practice address
26401 CROWN VALLEY PKWY, SUITE 101, MISSION VIEJO, CA 92691-6350
(949) 348-4000
Mailing address
26401 CROWN VALLEY PKWY, SUITE 101, MISSION VIEJO, CA 92691-6350
(949) 348-4000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G42640
CA
207X00000X
Orthopaedic Surgery Physician
G63599
CA
207X00000X
Orthopaedic Surgery Physician
G64377
CA
207X00000X
Orthopaedic Surgery Physician
G69562
CA
207XS0106X
Orthopaedic Hand Surgery Physician
G74361
CA
207XS0117X
Orthopaedic Surgery of the Spine Physician
A70607
CA
207XS0117X
Orthopaedic Surgery of the Spine Physician
G25458
CA
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
A108023
CA
208100000X
Physical Medicine & Rehabilitation Physician
A64745
CA
208100000X
Physical Medicine & Rehabilitation Physician
A80044
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ24045Z
BLUE SHIELD
CA
Enumeration date
04/28/2006
Last updated
10/15/2021
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