Provider Demographics
NPI:1437380441
Name:ACTIVE ORTHOPEDIC MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ACTIVE ORTHOPEDIC MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:209-216-5900
Mailing Address - Street 1:PO BOX 2120
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95381-2120
Mailing Address - Country:US
Mailing Address - Phone:209-216-5900
Mailing Address - Fax:209-216-5909
Practice Address - Street 1:1051 E TUOLUMNE RD
Practice Address - Street 2:103
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1546
Practice Address - Country:US
Practice Address - Phone:209-216-5900
Practice Address - Fax:209-216-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty