Provider Demographics
NPI:1336187475
Name:SAN BDNO MEDICAL ORTHOPAEDIC GROUP INC
Entity Type:Organization
Organization Name:SAN BDNO MEDICAL ORTHOPAEDIC GROUP INC
Other - Org Name:ARROWHEAD ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZZOUK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-557-1600
Mailing Address - Street 1:PO BOX 8520
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-1720
Mailing Address - Country:US
Mailing Address - Phone:909-557-1600
Mailing Address - Fax:909-557-1740
Practice Address - Street 1:1901 W LUGONIA AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-9704
Practice Address - Country:US
Practice Address - Phone:909-557-1600
Practice Address - Fax:909-557-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36913739207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29537ZMedicare ID - Type UnspecifiedREDLANDS CLINIC
CA0578500005Medicare NSC
CAFX956AMedicare PIN