Provider Demographics
NPI:1619398153
Name:ORTHONORCAL, INC.
Entity Type:Organization
Organization Name:ORTHONORCAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-412-8119
Mailing Address - Street 1:3803 S BASCOM AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7317
Mailing Address - Country:US
Mailing Address - Phone:408-412-8100
Mailing Address - Fax:408-412-8453
Practice Address - Street 1:4140 JADE ST
Practice Address - Street 2:STE 100
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010
Practice Address - Country:US
Practice Address - Phone:831-475-4024
Practice Address - Fax:408-412-8453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA770428611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFC771YMedicare UPIN
CAF26268Medicare UPIN
CAZZZ29917ZMedicare PIN