Provider Demographics
NPI:1629143581
Name:PACIFIC COAST ORTHOPEDICS INC
Entity Type:Organization
Organization Name:PACIFIC COAST ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:RAVALIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-648-8600
Mailing Address - Street 1:19 UPPER RAGSDALE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7837
Mailing Address - Country:US
Mailing Address - Phone:831-464-6200
Mailing Address - Fax:831-464-6204
Practice Address - Street 1:101 WILSON RD
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7864
Practice Address - Country:US
Practice Address - Phone:831-648-8600
Practice Address - Fax:831-920-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71729207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A717292Medicaid
H21172Medicare UPIN
CAZZZ30849ZMedicare PIN