Provider Demographics
NPI:1053445528
Name:CALIFORNIA ORTHOPAEDIC INSTITUTE MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:CALIFORNIA ORTHOPAEDIC INSTITUTE MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-291-8930
Mailing Address - Street 1:7485 MISSION VALLEY RD STE 104A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4422
Mailing Address - Country:US
Mailing Address - Phone:619-291-8930
Mailing Address - Fax:
Practice Address - Street 1:7485 MISSION VALLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4422
Practice Address - Country:US
Practice Address - Phone:619-291-8930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA ORTHOPAEDIC INSTITUTE MEDICAL ASSOC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG240Medicare ID - Type UnspecifiedINDEPENDENT DIAGNOSTIC TE
CA0320080001Medicare NSC