Provider Demographics
NPI:1477785665
Name:ORTHOPEDIC INSTITUTE OF THE BAY AREA
Entity type:Organization
Organization Name:ORTHOPEDIC INSTITUTE OF THE BAY AREA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-262-4262
Mailing Address - Street 1:100 S SAN MATEO DR
Mailing Address - Street 2:SUITE 424
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3805
Mailing Address - Country:US
Mailing Address - Phone:650-262-4262
Mailing Address - Fax:650-262-5862
Practice Address - Street 1:100 S SAN MATEO DR
Practice Address - Street 2:SUITE 424
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3805
Practice Address - Country:US
Practice Address - Phone:650-262-4262
Practice Address - Fax:650-262-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84190207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABE353ZOtherPTAN
CA1467548008OtherNPI