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Individual

NINOS M ODA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
15095 AMARGOSA ROAD, BLDG 1 STE 106, VICTORVILLE, CA 92394
(760) 245-6495
Mailing address
1801 ORANGE TREE LN STE 200, REDLANDS, CA 92374-4587

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01076386A
IN
207X00000X
Orthopaedic Surgery Physician
271683
NY
207X00000X
Orthopaedic Surgery Physician
4301106600
MI
207X00000X
Orthopaedic Surgery Physician
Primary
C161324
CA

Other

Enumeration date
09/04/2013
Last updated
09/13/2022
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