Organization
FULLERTON ORTHOPAEDIC SURGERY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEWART L SHANFIELD M.D. (PRESIDENT)
(714) 879-0050
Entity
Organization
Contact information
Practice address
17021 YORBA LINDA BLVD STE 100, YORBA LINDA, CA 92886-3715
(714) 996-6440
(714) 996-5831
Mailing address
17021 YORBA LINDA BLVD STE 100, YORBA LINDA, CA 92886-3715
(714) 996-6440
(714) 996-5831
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G45883
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W1365
MEDICARE ID - TYPE UNSPECIFIED
CA
Enumeration date
01/09/2008
Last updated
06/24/2009
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