Provider Demographics
NPI:1164847547
Name:NON-SURGICAL ORTHOPEDIC CENTER A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:NON-SURGICAL ORTHOPEDIC CENTER A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-707-7302
Mailing Address - Street 1:2170 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 117-122
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6203
Mailing Address - Country:US
Mailing Address - Phone:760-730-8060
Mailing Address - Fax:760-730-8061
Practice Address - Street 1:2170 S EL CAMINO REAL
Practice Address - Street 2:SUITE 117-122
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6203
Practice Address - Country:US
Practice Address - Phone:760-730-8060
Practice Address - Fax:760-730-8061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty