Provider Demographics
NPI:1093801524
Name:CALIFORNIA PACIFIC ORTHOPAEDICS AND SPORTS MEDICINE A MEDICAL CORPORAT
Entity Type:Organization
Organization Name:CALIFORNIA PACIFIC ORTHOPAEDICS AND SPORTS MEDICINE A MEDICAL CORPORAT
Other - Org Name:CALIFORNIA PACIFIC ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:URBANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-592-2017
Mailing Address - Street 1:3838 CALIFORNIA ST.
Mailing Address - Street 2:SUITE 715
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118
Mailing Address - Country:US
Mailing Address - Phone:415-592-2017
Mailing Address - Fax:415-592-0001
Practice Address - Street 1:3838 CALIFORNIA ST.
Practice Address - Street 2:SUITE 715
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118
Practice Address - Country:US
Practice Address - Phone:415-592-2017
Practice Address - Fax:415-592-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY48586YMedicare ID - Type UnspecifiedPROVIDER ID