Provider Demographics
NPI:1366643082
Name:ORANGE COAST ORTHOPEDIC & SPORTS MEDICINE GROUP
Entity Type:Organization
Organization Name:ORANGE COAST ORTHOPEDIC & SPORTS MEDICINE GROUP
Other - Org Name:SOUTH COAST PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTTERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-755-7006
Mailing Address - Street 1:1220 HEMLOCK WAY
Mailing Address - Street 2:STE 205
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3650
Mailing Address - Country:US
Mailing Address - Phone:714-755-7006
Mailing Address - Fax:714-545-2762
Practice Address - Street 1:1220 HEMLOCK WAY
Practice Address - Street 2:STE 205
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3650
Practice Address - Country:US
Practice Address - Phone:714-755-7006
Practice Address - Fax:714-545-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13356Medicare ID - Type UnspecifiedGROUP NUMBER