Provider Demographics
NPI:1518064732
Name:WEST BAY ORTHOPAEDIC MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:WEST BAY ORTHOPAEDIC MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-991-9400
Mailing Address - Street 1:901 CAMPUS DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4900
Mailing Address - Country:US
Mailing Address - Phone:650-991-9400
Mailing Address - Fax:650-991-2650
Practice Address - Street 1:901 CAMPUS DR
Practice Address - Street 2:SUITE 111
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4900
Practice Address - Country:US
Practice Address - Phone:650-991-9400
Practice Address - Fax:650-991-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ91132ZMedicare ID - Type Unspecified