Provider Demographics
NPI:1396003034
Name:ARMOUR X SPORTS IN ORTHOPEDIC MEDICINE
Entity Type:Organization
Organization Name:ARMOUR X SPORTS IN ORTHOPEDIC MEDICINE
Other - Org Name:AXIOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPURRO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPAS
Authorized Official - Phone:949-830-8160
Mailing Address - Street 1:22482 LAKE FOREST LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3024
Mailing Address - Country:US
Mailing Address - Phone:949-830-8160
Mailing Address - Fax:949-830-8160
Practice Address - Street 1:22482 LAKE FOREST LN
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3024
Practice Address - Country:US
Practice Address - Phone:949-830-8160
Practice Address - Fax:949-830-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit