Healthcare Provider Details

I. General information

NPI: 1508908518
Provider Name (Legal Business Name): SAN JOSE ORTHOPEDIC ASSOCIATES MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 SAMARITAN DR SUITE 210
SAN JOSE CA
95124-4008
US

IV. Provider business mailing address

2505 SAMARITAN DR SUITE 210
SAN JOSE CA
95124-4008
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-8300
  • Fax: 408-358-8301
Mailing address:
  • Phone: 408-358-8300
  • Fax: 408-358-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG33893
License Number StateCA

VIII. Authorized Official

Name: DR. MARK IRA GOLOD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 408-358-8300