Healthcare Provider Details

I. General information

NPI: 1154464329
Provider Name (Legal Business Name): PENINSULA ORTHOPEDIC ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 SULLIVAN AVE STE 330
DALY CITY CA
94015-2204
US

IV. Provider business mailing address

1850 SULLIVAN AVE STE 330
DALY CITY CA
94015-2204
US

V. Phone/Fax

Practice location:
  • Phone: 650-756-5630
  • Fax: 650-994-1155
Mailing address:
  • Phone: 650-756-5630
  • Fax: 650-994-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0208450001
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN CONRAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 650-756-5630