Healthcare Provider Details

I. General information

NPI: 1801976337
Provider Name (Legal Business Name): BRUCE ORISEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 NEW BRIGHTON RD
APTOS CA
95003-3521
US

IV. Provider business mailing address

114 NEW BRIGHTON RD
APTOS CA
95003-3521
US

V. Phone/Fax

Practice location:
  • Phone: 831-689-0862
  • Fax: 831-689-0862
Mailing address:
  • Phone: 831-689-0862
  • Fax: 831-689-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG39697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: