Provider Demographics
NPI:1780915744
Name:LOS ANGELES ORTHOPEDIC GROUP INC
Entity type:Organization
Organization Name:LOS ANGELES ORTHOPEDIC GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRIGUETE ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-633-0809
Mailing Address - Street 1:5257 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2121
Mailing Address - Country:US
Mailing Address - Phone:562-633-0809
Mailing Address - Fax:562-633-0857
Practice Address - Street 1:5257 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2121
Practice Address - Country:US
Practice Address - Phone:562-633-0809
Practice Address - Fax:562-633-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6403620001Medicare NSC