Provider Demographics
NPI:1649409905
Name:SPORTS ORTHOPEDIC AND REHABILITATION MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:SPORTS ORTHOPEDIC AND REHABILITATION MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
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:650-851-4900
Mailing Address - Street 1:550 S WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2544
Mailing Address - Country:US
Mailing Address - Phone:408-247-4900
Mailing Address - Fax:650-995-1202
Practice Address - Street 1:550 S WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2544
Practice Address - Country:US
Practice Address - Phone:408-247-4900
Practice Address - Fax:650-995-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ35710ZMedicare PIN
CAZZZ35709ZMedicare PIN
CA0724530002Medicare NSC
CA0724830001Medicare NSC