Provider Demographics
NPI:1396951968
Name:OSTEOPOROSIS CENTER OF IRVINE
Entity type:Organization
Organization Name:OSTEOPOROSIS CENTER OF IRVINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:BS,CNMT,CDT
Authorized Official - Phone:949-829-9756
Mailing Address - Street 1:26302 LA PAZ RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5328
Mailing Address - Country:US
Mailing Address - Phone:949-829-9756
Mailing Address - Fax:949-829-9185
Practice Address - Street 1:26302 LA PAZ RD
Practice Address - Street 2:SUITE 206
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5328
Practice Address - Country:US
Practice Address - Phone:949-829-9756
Practice Address - Fax:949-829-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC040332261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW12233OtherPTAN
CAW12233Medicare UPIN