Provider Demographics
NPI:1366944274
Name:JAX ORTHOPEDICS, INC.
Entity type:Organization
Organization Name:JAX ORTHOPEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNIE
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:TELARROJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-220-4400
Mailing Address - Street 1:9318 LUBEC ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3010
Mailing Address - Country:US
Mailing Address - Phone:562-682-7978
Mailing Address - Fax:424-220-8344
Practice Address - Street 1:1200 ROSECRANS AVE STE 110
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2470
Practice Address - Country:US
Practice Address - Phone:424-220-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83591207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty