Healthcare Provider Details

I. General information

NPI: 1114029980
Provider Name (Legal Business Name): SANTA CRUZ ORTHOPAEDIC INSTITUTE A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 JADE STREET SUITE 100
CAPITOLA CA
95010-3901
US

IV. Provider business mailing address

4140 JADE STREET SUITE 100
CAPITOLA CA
95010-3901
US

V. Phone/Fax

Practice location:
  • Phone: 831-475-4024
  • Fax: 831-475-4344
Mailing address:
  • Phone: 831-475-4024
  • Fax: 831-475-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG85551
License Number StateCA

VIII. Authorized Official

Name: DR. NICHOLAS ASHAN ABIDI
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 831-475-4024