Healthcare Provider Details

I. General information

NPI: 1083293716
Provider Name (Legal Business Name): ADVANCED REGENERATIVE ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 NORTHGATE DR STE 400
SAN RAFAEL CA
94903-3667
US

IV. Provider business mailing address

899 NORTHGATE DR STE 400
SAN RAFAEL CA
94903-3667
US

V. Phone/Fax

Practice location:
  • Phone: 415-223-7504
  • Fax: 415-223-7505
Mailing address:
  • Phone: 415-223-7504
  • Fax: 415-223-7505

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: PAUL HANDLEMAN
Title or Position: PHYSICIAN/PRESIDENT
Credential: DO
Phone: 415-223-7504