Seventeenth Street Orthopedic Specialty Medical Clinic, Inc

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

SEVENTEENTH STREET ORTHOPEDIC SPECIALTY MEDICAL CLINIC, INC

Practice address

1450 E 17TH St
# 100
Santa Ana, CA 92705-8510

Phone

(714) 565-1000

Fax

(714) 565-1974

NPI assigned

Nov 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Phyllis R Brourman, ESQ

Title

Attorney

Phone

(310) 657-2202

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336215474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 E 17TH ST",
            "address_2": "# 100",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927058510",
            "telephone_number": "714-565-1000",
            "fax_number": "714-565-1974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 E 17TH ST",
            "address_2": "# 100",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927058510",
            "telephone_number": "714-565-1000",
            "fax_number": "714-565-1974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEVENTEENTH STREET ORTHOPEDIC SPECIALTY MEDICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROURMAN",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ATTORNEY",
        "authorized_official_telephone_number": "310-657-2202",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ESQ"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Orthopaedic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.