Provider Demographics
NPI:1427094960
Name:ADVANCED ORTHOPEDICS AND SPORTS MEDICINE, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ADVANCED ORTHOPEDICS AND SPORTS MEDICINE, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-270-0882
Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92564-1007
Mailing Address - Country:US
Mailing Address - Phone:951-719-3330
Mailing Address - Fax:
Practice Address - Street 1:4234 RIVERWALK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-8510
Practice Address - Country:US
Practice Address - Phone:951-977-2500
Practice Address - Fax:951-977-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57575207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A6291OtherLICENSE
CAG57575OtherLICENSE NUMBER
CAG70713OtherLICENSE
CAZZZ05383ZMedicare UPIN
CAG57575OtherLICENSE NUMBER