Healthcare Provider Details

I. General information

NPI: 1649409905
Provider Name (Legal Business Name): SPORTS ORTHOPEDIC AND REHABILITATION MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S WINCHESTER BLVD
SAN JOSE CA
95128-2544
US

IV. Provider business mailing address

550 S WINCHESTER BLVD
SAN JOSE CA
95128-2544
US

V. Phone/Fax

Practice location:
  • Phone: 408-247-4900
  • Fax: 650-995-1202
Mailing address:
  • Phone: 408-247-4900
  • Fax: 650-995-1202

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: KAREN SOLLAR
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 650-851-4900