Provider Demographics
NPI:1396708988
Name:SOUTH BAY ORTHOPAEDIC SPECIALISTS MEDICAL CENTER A MEDICAL PARTNERSHIP
Entity type:Organization
Organization Name:SOUTH BAY ORTHOPAEDIC SPECIALISTS MEDICAL CENTER A MEDICAL PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:H
Authorized Official - Last Name:UNATIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-784-2355
Mailing Address - Street 1:23560 CRENSHAW BLVD
Mailing Address - Street 2:102 & 103
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5233
Mailing Address - Country:US
Mailing Address - Phone:310-784-2355
Mailing Address - Fax:310-517-1817
Practice Address - Street 1:23560 CRENSHAW BLVD
Practice Address - Street 2:102 & 103
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5233
Practice Address - Country:US
Practice Address - Phone:310-784-2355
Practice Address - Fax:310-517-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02606ZOtherBLUE SHIELD
CAW14514CMedicare ID - Type Unspecified
CA5386360001Medicare NSC