1255835203 NPI number — CALIFORNIA ORTHOPEDICS & SPINE INC

Table of content: (NPI 1255835203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255835203 NPI number — CALIFORNIA ORTHOPEDICS & SPINE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA ORTHOPEDICS & SPINE 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:
1255835203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 BON AIR ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARKSPUR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94939-1123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-927-5300
Provider Business Mailing Address Fax Number:
415-927-6860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7100 REDWOOD BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NOVATO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-492-1600
Provider Business Practice Location Address Fax Number:
415-493-2542
Provider Enumeration Date:
03/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DAILEY
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ORTHOPEDIC SURGEON
Authorized Official Telephone Number:
415-927-5300

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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