1376875062 NPI number — CALIFORNIA PACIFIC ORTHOPAEDIC & SPORTS MEDICINE

Table of content: (NPI 1376875062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376875062 NPI number — CALIFORNIA PACIFIC ORTHOPAEDIC & SPORTS MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA PACIFIC ORTHOPAEDIC & SPORTS MEDICINE
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:
Provider Other Organization Name Type Code:
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:
1376875062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3838 CALIFORNIA ST
Provider Second Line Business Mailing Address:
715
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94118-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-668-8010
Provider Business Mailing Address Fax Number:
415-592-0092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3838 CALIFORNIA ST
Provider Second Line Business Practice Location Address:
715
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94118-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-668-8010
Provider Business Practice Location Address Fax Number:
415-592-0092
Provider Enumeration Date:
02/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WELKER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CAO
Authorized Official Telephone Number:
415-592-2017

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: YYY48586Y . This is a "MEDICARE GROUP PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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