Healthcare Provider Details

I. General information

NPI: 1619398153
Provider Name (Legal Business Name): ORTHONORCAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 JADE ST STE 100
CAPITOLA CA
95010
US

IV. Provider business mailing address

3803 S BASCOM AVE SUITE 102
CAMPBELL CA
95008-7317
US

V. Phone/Fax

Practice location:
  • Phone: 831-475-4024
  • Fax: 408-412-8453
Mailing address:
  • Phone: 408-412-8100
  • Fax: 408-412-8453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number770428611
License Number StateCA

VIII. Authorized Official

Name: KAREN SOLLAR
Title or Position: CEO
Credential:
Phone: 408-412-8119