Provider Demographics
NPI:1073567467
Name:PROFESSIONAL ORTHOPEDIC SYSTEMS OF AUBURN
Entity Type:Organization
Organization Name:PROFESSIONAL ORTHOPEDIC SYSTEMS OF AUBURN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TABLADA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:916-331-3537
Mailing Address - Street 1:5049 COLLEGE OAK DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4630
Mailing Address - Country:US
Mailing Address - Phone:916-331-3537
Mailing Address - Fax:916-331-3587
Practice Address - Street 1:1237 GRASS VALLEY HWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3413
Practice Address - Country:US
Practice Address - Phone:530-885-2712
Practice Address - Fax:916-331-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGFC000130Medicaid
CAGFC000130Medicaid
CACPO00891OtherABC-MM