Provider Demographics
NPI:1801301080
Name:ORTHOPEDIC SPECIALTY CENTER OF NORTHERN CALIFORNIA INC
Entity type:Organization
Organization Name:ORTHOPEDIC SPECIALTY CENTER OF NORTHERN CALIFORNIA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:JAMIESON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-918-2952
Mailing Address - Street 1:1013 GALLERIA BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-1363
Mailing Address - Country:US
Mailing Address - Phone:916-918-2952
Mailing Address - Fax:916-918-2953
Practice Address - Street 1:1013 GALLERIA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1363
Practice Address - Country:US
Practice Address - Phone:916-622-3609
Practice Address - Fax:916-780-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-09
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12739207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A12739OtherLICENSE NUMBER