Provider Demographics
NPI:1790847895
Name:SOUTHERN CALIFORNIA CENTER FOR OCCUPATIONAL ORTHOPAEDICS
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA CENTER FOR OCCUPATIONAL ORTHOPAEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-932-1654
Mailing Address - Street 1:6221 WILSHIRE BLVD STE 419
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5224
Mailing Address - Country:US
Mailing Address - Phone:323-932-1654
Mailing Address - Fax:323-932-0460
Practice Address - Street 1:6221 WILSHIRE BLVD STE 419
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5224
Practice Address - Country:US
Practice Address - Phone:323-932-1654
Practice Address - Fax:323-932-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG059151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16115Medicare ID - Type Unspecified
CAA93530Medicare UPIN