Provider Demographics
NPI:1619482387
Name:CALIFORNIA SPORTS AND ORTHOPAEDIC
Entity Type:Organization
Organization Name:CALIFORNIA SPORTS AND ORTHOPAEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-704-7760
Mailing Address - Street 1:2999 REGENT ST STE 225
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2117
Mailing Address - Country:US
Mailing Address - Phone:510-704-7760
Mailing Address - Fax:510-704-7765
Practice Address - Street 1:350 30TH ST STE 530
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3426
Practice Address - Country:US
Practice Address - Phone:510-422-5150
Practice Address - Fax:510-422-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty