Provider Demographics
NPI:1316551864
Name:ORTHOPEDIC AND SPORTS MEDICINE INSTITUTE PLUS SPINE INC
Entity Type:Organization
Organization Name:ORTHOPEDIC AND SPORTS MEDICINE INSTITUTE PLUS SPINE INC
Other - Org Name:ORTHOPEDIC AND SPORTS MEDICINE INSTITUTE PLUS SPINE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-692-1475
Mailing Address - Street 1:359 N SAN MATEO DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2584
Mailing Address - Country:US
Mailing Address - Phone:650-685-7100
Mailing Address - Fax:
Practice Address - Street 1:359 N SAN MATEO DR STE 1
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2584
Practice Address - Country:US
Practice Address - Phone:650-685-7100
Practice Address - Fax:650-685-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty