Provider Demographics
NPI:1720218829
Name:ORTHO MEDIX GROUP INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ORTHO MEDIX GROUP INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARTYOUN
Authorized Official - Middle Name:I
Authorized Official - Last Name:YOUSIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-548-1635
Mailing Address - Street 1:P.O BOX 11300
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91226
Mailing Address - Country:US
Mailing Address - Phone:818-548-1635
Mailing Address - Fax:
Practice Address - Street 1:800 S CENTRAL AVE # 303
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4370
Practice Address - Country:US
Practice Address - Phone:818-648-1635
Practice Address - Fax:818-247-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9922111NX0800X
CAA040779174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty