Provider Demographics
NPI:1114029980
Name:SANTA CRUZ ORTHOPAEDIC INSTITUTE A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SANTA CRUZ ORTHOPAEDIC INSTITUTE A MEDICAL CORPORATION
Other - Org Name:SANTA CRUZ ORTHOPAEDIC INSTITUTE A MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ASHAN
Authorized Official - Last Name:ABIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-475-4024
Mailing Address - Street 1:4140 JADE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3901
Mailing Address - Country:US
Mailing Address - Phone:831-475-4024
Mailing Address - Fax:831-475-4344
Practice Address - Street 1:4140 JADE STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3901
Practice Address - Country:US
Practice Address - Phone:831-475-4024
Practice Address - Fax:831-475-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85551174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ45712Medicare UPIN
CADS852ZMedicare UPIN
CAP59612Medicare UPIN
CAG47135Medicare UPIN
CAA88014Medicare UPIN