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NPI Code Detail

MEDICARE: SPORTS ORTHOPEDIC AND REHABILITATION MEDICINE ASSOCIATES

MEDICARE: SPORTS ORTHOPEDIC AND REHABILITATION MEDICINE ASSOCIATES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician
2207XS0106XOrthopaedic Hand Surgery Physician
3207XX0005XSports Medicine (Orthopaedic Surgery) Physician
42081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician
5213ES0000XSports Medicine Podiatrist
6213ES0103XFoot & Ankle Surgery Podiatrist
7207RR0500XRheumatology Physician

General Provider Information

NPI Number : 1538227707
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPORTS ORTHOPEDIC AND REHABILITATION MEDICINE ASSOCIATES
Provider Business Mailing Address
First Line : 500 ARGUELLO ST
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94063-1566
Country : US
Telephone Number : 650-851-4900
Fax Number : 408-556-8415
Provider Business Practice Location Address
First Line : 500 ARGUELLO ST
Second Line : STE 100
City : REDWOOD CITY
State : CA
Zip : 94063-1566
Country : US
Telephone Number : 650-851-4900
Fax Number : 408-556-8415
Authorized Official
Title or Position : MANAGER
Name : MALLIKA BASU
Credential :
Telephone Number : 408-556-8407
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/24/2014

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Directions to “SPORTS ORTHOPEDIC AND REHABILITATION MEDICINE ASSOCIATES ” Practice Location

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