Provider Demographics
NPI:1841379831
Name:CALIFORNIA SPORTS AND ORTHOPAEDIC INSTITUTE INC
Entity Type:Organization
Organization Name:CALIFORNIA SPORTS AND ORTHOPAEDIC INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:EPPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-704-7760
Mailing Address - Street 1:2999 REGENT ST
Mailing Address - Street 2:STE 225
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2146
Mailing Address - Country:US
Mailing Address - Phone:510-704-7760
Mailing Address - Fax:510-704-7765
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:STE 225
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2146
Practice Address - Country:US
Practice Address - Phone:510-704-7760
Practice Address - Fax:510-704-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67022207RS0010X
CAG63226207X00000X
CAA78633207X00000X
CAPT25357208100000X
CAPT21053208100000X
CAPA15294363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64579ZOtherGROUP NUMBER
CAZZZ32796ZMedicare PIN