Provider Demographics
NPI:1053314625
Name:SOUTH COUNTY ORTHOPEDIC SPECIALISTS
Entity Type:Organization
Organization Name:SOUTH COUNTY ORTHOPEDIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GERSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-586-3200
Mailing Address - Street 1:PO BOX 31063
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92654-1063
Mailing Address - Country:US
Mailing Address - Phone:949-586-3200
Mailing Address - Fax:949-900-2136
Practice Address - Street 1:24331 EL TORO RD
Practice Address - Street 2:STE 200
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2753
Practice Address - Country:US
Practice Address - Phone:949-586-3200
Practice Address - Fax:949-900-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACN9515OtherMEDICARE RAILROAD
CAGR0064200OtherCAL-OPTIMA
CAGR0064200OtherCAL-OPTIMA
CAW13346Medicare PIN
CACN9515OtherMEDICARE RAILROAD