Organization
OPTIMAL ORTHOPEDIC MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA ROGER (OFFICE MANAGER)
(714) 434-8663
Entity
Organization
Contact information
Practice address
17400 IRVINE BLVD STE L, TUSTIN, CA 92780-3030
(714) 434-8663
Mailing address
PO BOX 1309, NEWPORT BEACH, CA 92659-0109
(714) 434-8663
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G53516
CA
Other
Enumeration date
11/06/2007
Last updated
11/06/2007
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