Provider Demographics
NPI:1558531780
Name:ORTHOPEDIC CARE CENTER OF LOS ANGELES
Entity Type:Organization
Organization Name:ORTHOPEDIC CARE CENTER OF LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:RESNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-995-8590
Mailing Address - Street 1:17525 VENTURA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3843
Mailing Address - Country:US
Mailing Address - Phone:818-995-8590
Mailing Address - Fax:818-285-5955
Practice Address - Street 1:800 S. FAIRMOUNT STREET
Practice Address - Street 2:SUITE 410
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-796-1787
Practice Address - Fax:626-796-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty