Provider Demographics
NPI:1326178245
Name:MAMMOTH LAKES ORTHOPEDICS ASSOCIATES
Entity Type:Organization
Organization Name:MAMMOTH LAKES ORTHOPEDICS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:STRIPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-508-7638
Mailing Address - Street 1:23600 TELO AVE
Mailing Address - Street 2:SUITE #180
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4035
Mailing Address - Country:US
Mailing Address - Phone:310-257-1500
Mailing Address - Fax:310-257-1506
Practice Address - Street 1:452 OLD MAMMOTH ROAD
Practice Address - Street 2:SUITE R
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-5021
Practice Address - Country:US
Practice Address - Phone:310-924-8688
Practice Address - Fax:760-924-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG075766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty