Provider Demographics
NPI:1295997047
Name:CALIFORNIA ORTHOPAEDIC INSTITUTE MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:CALIFORNIA ORTHOPAEDIC INSTITUTE MEDICAL ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-291-8930
Mailing Address - Street 1:7485 MISSION VALLEY RD
Mailing Address - Street 2:SUITE #104A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4422
Mailing Address - Country:US
Mailing Address - Phone:619-291-8930
Mailing Address - Fax:
Practice Address - Street 1:1349 CAMINO DEL MAR
Practice Address - Street 2:SUITE F
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2553
Practice Address - Country:US
Practice Address - Phone:619-291-8930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0002270Medicaid
CAW1762Medicare PIN