Provider Demographics
NPI:1780705566
Name:ORANGE COUNTY ORTHOPAEDICS & SPORTS MEDICAL GROUP, INC
Entity type:Organization
Organization Name:ORANGE COUNTY ORTHOPAEDICS & SPORTS MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-451-1454
Mailing Address - Street 1:24022 CALLE DE LA PLATA STE 415
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3630
Mailing Address - Country:US
Mailing Address - Phone:949-451-1454
Mailing Address - Fax:949-451-1452
Practice Address - Street 1:24022 CALLE DE LA PLATA STE 415
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3630
Practice Address - Country:US
Practice Address - Phone:949-451-1454
Practice Address - Fax:949-451-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14970Medicare ID - Type Unspecified