Provider Demographics
NPI:1710305602
Name:CENTER FOR ADVANCED ORTHOPEDICS AND SPORTS MEDICINE INC.
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED ORTHOPEDICS AND SPORTS MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMY
Authorized Official - Middle Name:N
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-641-2640
Mailing Address - Street 1:30025 ALICIA PKWY STE 157
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2090
Mailing Address - Country:US
Mailing Address - Phone:949-493-0616
Mailing Address - Fax:949-493-0622
Practice Address - Street 1:18111 BROOKHURST ST STE 2600
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-200-1010
Practice Address - Fax:714-200-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86043174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty