Provider Demographics
NPI:1376875062
Name:CALIFORNIA PACIFIC ORTHOPAEDICS AND SPORTS MEDICINE A MEDICAL CORPORAT
Entity type:Organization
Organization Name:CALIFORNIA PACIFIC ORTHOPAEDICS AND SPORTS MEDICINE A MEDICAL CORPORAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-668-8010
Mailing Address - Street 1:3838 CALIFORNIA ST
Mailing Address - Street 2:715
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1522
Mailing Address - Country:US
Mailing Address - Phone:415-668-8010
Mailing Address - Fax:415-592-0092
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:715
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-668-8010
Practice Address - Fax:415-592-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0324200001OtherMEDICARE GROUP PROVIDER NUMBER DMEPOS
CA0324200001Medicare NSC