Healthcare Provider Details

I. General information

NPI: 1255259727
Provider Name (Legal Business Name): ORTHONOVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 DONAHUE ST APT 24
SAUSALITO CA
94965-1260
US

IV. Provider business mailing address

117 DONAHUE ST APT 24
SAUSALITO CA
94965-1260
US

V. Phone/Fax

Practice location:
  • Phone: 415-450-7184
  • Fax:
Mailing address:
  • Phone: 415-450-7184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANOOSHA SALEEM
Title or Position: BUSINESS MANAGER
Credential:
Phone: 415-450-7184