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Organization

SPORTS AND SPINE ORTHOPAEDICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. NORA MIES (PATIENT ACCOUNT REP)
(310) 375-8700
Entity
Organization

Contact information

Practice address
23456 HAWTHORNE BLVD, SUITE 200 BUILDING 5, TORRANCE, CA 90505-4716
(310) 375-8700
Mailing address
23456 HAWTHORNE BLVD, SUITE 200 BUILDING 5, TORRANCE, CA 90505-4716
(310) 375-8700

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A62201
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
601860000
DOL
CA
01
6332760001
NATIONAL SUPPLIER CLEARINGHOUSE
CA
Enumeration date
06/06/2006
Last updated
01/28/2014
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