Basic Information
| Provider Information | |||||||||
| NPI: | 1356525737 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPEDIC TRAUMA SPECIALISTS OF ORANGE COUNTY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26730 CROWN VALLEY PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493642154 | ||||||||
| FaxNumber: | 9493642110 | ||||||||
| Practice Location | |||||||||
| Address1: | 26730 CROWN VALLEY PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493642154 | ||||||||
| FaxNumber: | 9493642110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2007 | ||||||||
| LastUpdateDate: | 02/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | WILKENS | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9493642154 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0801X | C3069768 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
No ID Information.