Healthcare Provider Details

I. General information

NPI: 1700983087
Provider Name (Legal Business Name): ORTHOPEDIC EVALUATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DANIEL BURNHAM CT STE 365-C
SAN FRANCISCO CA
94109-5490
US

IV. Provider business mailing address

1 DANIEL BURNHAM CT STE 365-C
SAN FRANCISCO CA
94109-5490
US

V. Phone/Fax

Practice location:
  • Phone: 415-202-1920
  • Fax: 415-922-6344
Mailing address:
  • Phone: 415-202-1920
  • Fax: 415-922-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG17949
License Number StateCA

VIII. Authorized Official

Name: DR. JOEL W RENBAUM
Title or Position: OWNER
Credential: MD
Phone: 415-202-1920