Provider Demographics
NPI:1780956466
Name:DIRECT ORTHO CARE LLC
Entity type:Organization
Organization Name:DIRECT ORTHO CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:N/A
Authorized Official - Last Name:WILLETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-593-1535
Mailing Address - Street 1:9114 ADAMS AVE STE 132
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-3405
Mailing Address - Country:US
Mailing Address - Phone:714-593-1535
Mailing Address - Fax:714-593-1537
Practice Address - Street 1:9114 ADAMS AVE STE 132
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-3405
Practice Address - Country:US
Practice Address - Phone:714-593-1535
Practice Address - Fax:714-593-1537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy