Provider Demographics
NPI:1841557691
Name:SKYLAR ORTHOPEDICS A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SKYLAR ORTHOPEDICS A MEDICAL CORPORATION
Other - Org Name:FRANK GIACOBETTI, M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNIE
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:TELARROJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-447-4787
Mailing Address - Street 1:302 W LA VETA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2607
Mailing Address - Country:US
Mailing Address - Phone:714-769-8400
Mailing Address - Fax:714-769-8381
Practice Address - Street 1:302 W LA VETA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2607
Practice Address - Country:US
Practice Address - Phone:714-769-8400
Practice Address - Fax:714-769-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG083591174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty