Basic Information
| Provider Information | |||||||||
| NPI: | 1811460421 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SM ORTHO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1880 CENTURY PARK E STE 200 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900671602 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1880 CENTURY PARK E STE 200 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900671602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108543800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2019 | ||||||||
| LastUpdateDate: | 01/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | MELAMED | ||||||||
| AuthorizedOfficialFirstName: | HOOMAN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3108543800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.