Provider Demographics
NPI:1811045313
Name:ORTHONORCAL, INC
Entity Type:Organization
Organization Name:ORTHONORCAL, INC
Other - Org Name:ORTHONORCAL, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIANS-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-412-8100
Mailing Address - Street 1:3803 S BASCOM AVE STE 102
Mailing Address - Street 2:
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:408-369-9035
Practice Address - Street 1:3803 S BASCOM AVE STE 102
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7317
Practice Address - Country:US
Practice Address - Phone:408-412-8100
Practice Address - Fax:408-369-9035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHONORCAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2013-05-15
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
CAZZZ29917ZMedicare PIN
CAF26268Medicare UPIN
CAFC771YMedicare UPIN