Provider Demographics
NPI:1336120278
Name:MATTHEW J PAUTZ
Entity Type:Organization
Organization Name:MATTHEW J PAUTZ
Other - Org Name:ORTHOPAEDIC INSTITUTE OF CALIFORNIA
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-245-2663
Mailing Address - Street 1:20258 HIGHWAY 18
Mailing Address - Street 2:#430-413
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-6197
Mailing Address - Country:US
Mailing Address - Phone:760-245-2663
Mailing Address - Fax:760-245-2668
Practice Address - Street 1:18031 US HIGHWAY 18 STE A
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2152
Practice Address - Country:US
Practice Address - Phone:760-245-2663
Practice Address - Fax:760-245-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7163207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13473ZOtherBLUE SHIELD OF CALIFORNIA
CADC9755OtherMEDICARE RAILROAD