Basic Information
Provider Information | |||||||||
NPI: | 1285974725 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CENTER FOR HIP PRESERVATION AND CHILDREN'S ORTHOPAEDICS INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
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OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 23052 ALICIA PKWY | ||||||||
Address2: | # 619 | ||||||||
City: | MISSION VIEJO | ||||||||
State: | CA | ||||||||
PostalCode: | 926921643 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7148089797 | ||||||||
FaxNumber: | 7148089393 | ||||||||
Practice Location | |||||||||
Address1: | 2023 W VISTA WAY | ||||||||
Address2: | SUITE B | ||||||||
City: | VISTA | ||||||||
State: | CA | ||||||||
PostalCode: | 920836030 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7607265800 | ||||||||
FaxNumber: | 7607265942 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/20/2013 | ||||||||
LastUpdateDate: | 02/14/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HOLSALKAR | ||||||||
AuthorizedOfficialFirstName: | HARISH | ||||||||
AuthorizedOfficialMiddleName: | SADANAND | ||||||||
AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 7607265800 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XP3100X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery |
No ID Information.