Organization · NPI-2

1st Industrial Medical Group

Podiatrist · Orange, CA

NPI number1689863995

StatusActive

Last updated in NPPESJun 24, 2008

Details

NPI: 1689863995
Entity type: Organization (NPI-2)
Legal business name: 1st Industrial Medical Group
Organization subpart: No
Enumeration date: Oct 23, 2007
Last updated: Jun 24, 2008

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
213E00000X	Podiatrist	–	–	Yes
111N00000X	Chiropractor	–	–
207LP2900X	Anesthesiology, Pain Medicine	–	–
207R00000X	Internal Medicine	–	–
207XX0004X	Orthopaedic Surgery, Foot and Ankle Surgery	–	–
208100000X	Physical Medicine & Rehabilitation	–	–
2086S0122X	Surgery, Plastic and Reconstructive Surgery	–	–
208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery)	–	–

Practice location

1234 W Chapman Ave
Suite 204
Orange, CA 92868-2862

Phone 714-289-4693 · Fax 714-289-4698

Mailing address

1234 W Chapman Ave
Suite # 204
Orange, CA 92868-2862

Phone 714-289-4693 · Fax 714-289-4698

Authorized official

Mark W Bennallack
Co Owner
7142894693

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