Healthcare Provider Details

I. General information

NPI: 1912333659
Provider Name (Legal Business Name): ORTHONORCAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 JADE ST SUITE 100
CAPITOLA CA
95010-3956
US

IV. Provider business mailing address

4140 JADE ST SUITE 100
CAPITOLA CA
95010-3956
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA75584
License Number StateCA

VIII. Authorized Official

Name: DR. NATHANIEL P COHEN
Title or Position: PHYSICIAN-PRESIDENT
Credential: M.D.
Phone: 831-475-4024