Provider Demographics
NPI:1669067963
Name:SOUTHLAND ORTHO SOLUTIONS, LLC
Entity type:Organization
Organization Name:SOUTHLAND ORTHO SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-433-5115
Mailing Address - Street 1:27702 CROWN VALLEY PARKWAY
Mailing Address - Street 2:SUITE D-4 #230
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694
Mailing Address - Country:US
Mailing Address - Phone:949-433-5115
Mailing Address - Fax:
Practice Address - Street 1:23362 PERALTA DR STE 2
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1711
Practice Address - Country:US
Practice Address - Phone:949-328-9622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies