Provider Demographics
NPI:1083667034
Name:STERLING B MUTZ MD INC JULIO TALEISNIK MD INC ET AL
Entity Type:Organization
Organization Name:STERLING B MUTZ MD INC JULIO TALEISNIK MD INC ET AL
Other - Org Name:THE HAND CARE CENTER SHOULDER AND ELBOW INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:TERESE
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-835-6500
Mailing Address - Street 1:1140 W LA VETA AVE
Mailing Address - Street 2:SUITE 860
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-835-6500
Mailing Address - Fax:714-541-6105
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:SUITE 860
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-835-6500
Practice Address - Fax:714-541-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1202180001Medicare NSC
CAW14105Medicare PIN