Provider Demographics
NPI:1235210089
Name:EASTSIDE ORTHOPEDIC MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:EASTSIDE ORTHOPEDIC MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAPANTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-289-0718
Mailing Address - Street 1:880 S ATLANTIC BLVD
Mailing Address - Street 2:205
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4700
Mailing Address - Country:US
Mailing Address - Phone:626-289-0178
Mailing Address - Fax:626-308-2083
Practice Address - Street 1:880 S ATLANTIC BLVD
Practice Address - Street 2:205
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4700
Practice Address - Country:US
Practice Address - Phone:626-289-0178
Practice Address - Fax:626-308-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27036174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11281OtherMEDICARE
CA5825400001Medicare NSC