Provider Demographics
NPI:1376875062
Name:CALIFORNIA PACIFIC ORTHOPAEDIC & SPORTS MEDICINE
Entity Type:Organization
Organization Name:CALIFORNIA PACIFIC ORTHOPAEDIC & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-592-2017
Mailing Address - Street 1:3838 CALIFORNIA ST
Mailing Address - Street 2:715
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1522
Mailing Address - Country:US
Mailing Address - Phone:415-668-8010
Mailing Address - Fax:415-592-0092
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:715
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-668-8010
Practice Address - Fax:415-592-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY48586YOtherMEDICARE GROUP PROVIDER NUMBER
CA0324200001Medicare NSC