Healthcare Provider Details

I. General information

NPI: 1518412659
Provider Name (Legal Business Name): ORTHONORCAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 JADE STREET SUITE 100
CAPITOLA CA
95010
US

IV. Provider business mailing address

340 DARDANELLI LN STE 10
LOS GATOS CA
95032-1418
US

V. Phone/Fax

Practice location:
  • Phone: 408-412-8100
  • Fax:
Mailing address:
  • Phone: 408-412-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS ABIDI
Title or Position: PARTNER
Credential: MD
Phone: 831-475-4024