=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033579529
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHONORCAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2016
-----------------------------------------------------
Last Update Date | 02/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14911 NATIONAL AVE SUITE 6
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-2632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-358-2757
-----------------------------------------------------
Fax | 408-358-2089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14911 NATIONAL AVE SUITE 6
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-2632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-358-2757
-----------------------------------------------------
Fax | 408-358-2089
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | NATHANIEL P COHEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 408-412-8100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------