1821475096 NPI number — MONTEREY PENINSULA ORTHOPEDIC & SPORTS MEDICINE INSTITUTE

Table of content: (NPI 1821475096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821475096 NPI number — MONTEREY PENINSULA ORTHOPEDIC & SPORTS MEDICINE INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTEREY PENINSULA ORTHOPEDIC & SPORTS MEDICINE INSTITUTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MONTEREY PENINSULA ORTHOPEDIC & SPORTS MEDICINE INSTITUTE/URGENCY MED
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821475096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 SUMMA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APTOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95003-5547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-704-3030
Provider Business Mailing Address Fax Number:
831-657-0161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 SUMMA CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APTOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95003-5547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-704-3030
Provider Business Practice Location Address Fax Number:
831-657-0161
Provider Enumeration Date:
04/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BELISHI
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
831-643-9788

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  G43197 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081P2900X , with the licence number: 20A6688 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081S0010X , with the licence number: 20A6704 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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