Healthcare Provider Details

I. General information

NPI: 1316551864
Provider Name (Legal Business Name): ORTHOPEDIC AND SPORTS MEDICINE INSTITUTE PLUS SPINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 08/13/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 N SAN MATEO DR STE 1
SAN MATEO CA
94401-2584
US

IV. Provider business mailing address

359 N SAN MATEO DR STE 1
SAN MATEO CA
94401-2584
US

V. Phone/Fax

Practice location:
  • Phone: 650-685-7100
  • Fax: 650-685-7109
Mailing address:
  • Phone: 650-685-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA DEGHI
Title or Position: OFFICE MANAGER
Credential:
Phone: 650-692-1475