Provider Demographics
NPI:1568629103
Name:WEST COAST ORTHOPEDICS INC
Entity Type:Organization
Organization Name:WEST COAST ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-508-4123
Mailing Address - Street 1:18102 IRVINE BOULEVARD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3423
Mailing Address - Country:US
Mailing Address - Phone:714-508-4123
Mailing Address - Fax:714-508-4134
Practice Address - Street 1:3325 PALO VERDE
Practice Address - Street 2:SUITE 205
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808
Practice Address - Country:US
Practice Address - Phone:562-425-1802
Practice Address - Fax:562-425-1804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP36888261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center