Provider Demographics
NPI:1043607823
Name:ORTHO SURG CARE, INC.
Entity Type:Organization
Organization Name:ORTHO SURG CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-862-2855
Mailing Address - Street 1:12223 HIGHLAND AVE
Mailing Address - Street 2:SUITE 106-442
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2574
Mailing Address - Country:US
Mailing Address - Phone:855-862-2855
Mailing Address - Fax:
Practice Address - Street 1:9401 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5335
Practice Address - Country:US
Practice Address - Phone:855-862-2855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75305332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies