Provider Demographics
NPI:1043719206
Name:SOUTHERN CALIFORNIA ORTHOPEDIC INSTITUTE L.P
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA ORTHOPEDIC INSTITUTE L.P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./ ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GUANCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-901-6600
Mailing Address - Street 1:6815 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3796
Mailing Address - Country:US
Mailing Address - Phone:818-901-6600
Mailing Address - Fax:818-997-7826
Practice Address - Street 1:4100 EMPIRE DR STE 120
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0408
Practice Address - Country:US
Practice Address - Phone:805-328-5565
Practice Address - Fax:805-328-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site