1720126824 NPI number — CAPSTONE ORTHOPEDIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720126824 NPI number — CAPSTONE ORTHOPEDIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPSTONE ORTHOPEDIC, INC.
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:
6
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:
1720126824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3553 CASTRO VALLEY BLVD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CASTRO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94546-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-537-1210
Provider Business Mailing Address Fax Number:
510-537-1082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7015 N CHESTNUT AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-0349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-298-0321
Provider Business Practice Location Address Fax Number:
559-298-7164
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
209-612-6168

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GXC 000923 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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