Provider Demographics
NPI:1295745271
Name:NORTH BAY ORTHOPAEDIC ASSOCIATES INC
Entity type:Organization
Organization Name:NORTH BAY ORTHOPAEDIC ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-649-1111
Mailing Address - Street 1:P.O. BOX 1483
Mailing Address - Street 2:ALAMO
Mailing Address - City:CA
Mailing Address - State:CA
Mailing Address - Zip Code:94507
Mailing Address - Country:US
Mailing Address - Phone:707-649-1111
Mailing Address - Fax:707-649-1045
Practice Address - Street 1:1460 NORTH CAMINO ALTO
Practice Address - Street 2:SUITE 210
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2567
Practice Address - Country:US
Practice Address - Phone:707-649-1111
Practice Address - Fax:707-649-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68196207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F96356Medicare UPIN
CA0556130001Medicare NSC
ZZZ83455ZMedicare ID - Type Unspecified