Provider Demographics
NPI:1346785649
Name:ORTHOPEDIC AND SPINE INSTITUTE OF SOUTHERN CALIFORNIA, INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC AND SPINE INSTITUTE OF SOUTHERN CALIFORNIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:R
Authorized Official - Last Name:CALDERONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-484-2783
Mailing Address - Street 1:2486 N PONDEROSA DR
Mailing Address - Street 2:STE D114
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2376
Mailing Address - Country:US
Mailing Address - Phone:805-484-2783
Mailing Address - Fax:805-987-8519
Practice Address - Street 1:2486 N PONDEROSA DR
Practice Address - Street 2:STE D114
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2376
Practice Address - Country:US
Practice Address - Phone:805-484-2783
Practice Address - Fax:805-987-8519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-23
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5456757OtherAETNA
CAZZZ00347SOtherBLUE SHIELD PIN
CAZZZ00347SOtherBLUE SHIELD PIN