Provider Demographics
NPI:1598872657
Name:CORONA ORTHOPAEDIC ASSOCIATES MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CORONA ORTHOPAEDIC ASSOCIATES MEDICAL GROUP INC
Other - Org Name:CORONA-TEMECULA ORTHOPAEDIC ASSOCIATES MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:BAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-735-6060
Mailing Address - Street 1:341 MAGNOLIA AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3331
Mailing Address - Country:US
Mailing Address - Phone:951-735-6060
Mailing Address - Fax:951-735-4510
Practice Address - Street 1:341 MAGNOLIA AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3331
Practice Address - Country:US
Practice Address - Phone:951-735-6060
Practice Address - Fax:951-735-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI7854OtherRAIL ROAD MEDICARE
ZZZ51830ZOtherBLUE SHIELD OF CALIFORNIA
CA925392BMedicaid
CAGR0070300Medicaid
CA1254420001Medicare NSC
CAZZZ11111ZMedicare PIN