Healthcare Provider Details

I. General information

NPI: 1194387290
Provider Name (Legal Business Name): NORTHERN CALIFORNIA ORTHOPAEDIC ASSOCIATES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 E MAIN ST STE 201
GRASS VALLEY CA
95945-5724
US

IV. Provider business mailing address

75 SCRIPPS DR
SACRAMENTO CA
95825-6320
US

V. Phone/Fax

Practice location:
  • Phone: 916-512-6262
  • Fax:
Mailing address:
  • Phone: 916-512-6262
  • Fax:

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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: AARON CASK
Title or Position: ADMINISTRATOR
Credential:
Phone: 916-512-6262