Healthcare Provider Details

I. General information

NPI: 1992027593
Provider Name (Legal Business Name): PACIFIC CREST ORTHOPEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3338 17TH ST STE 100
SAN FRANCISCO CA
94110-7213
US

IV. Provider business mailing address

PO BOX 53305
PHOENIX AZ
85072-3305
US

V. Phone/Fax

Practice location:
  • Phone: 415-923-0944
  • Fax: 415-923-5896
Mailing address:
  • Phone:
  • Fax: 415-923-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG65796
License Number StateCA

VIII. Authorized Official

Name: NYIA DOHRMANN
Title or Position: OFFICE MANAGER
Credential:
Phone: 415-390-0099