Provider Demographics
NPI:1912333659
Name:ORTHONORCAL, INC
Entity Type:Organization
Organization Name:ORTHONORCAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-475-4024
Mailing Address - Street 1:4140 JADE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4140 JADE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3956
Practice Address - Country:US
Practice Address - Phone:831-475-4024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75584207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFY744AOtherMEDICARE PTAN NUMBER
CAA75584OtherDR.COHEN MEDICARE PTAN NUMBER