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General NPI Number Information
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NPI Number | 1114029980
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Entity Type | Organization
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Legal Business Name | SANTA CRUZ ORTHOPAEDIC INSTITUTE A MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 4140 JADE STREET SUITE 100
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City | CAPITOLA
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State | CA
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Zip | 95010-3901
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Country | US
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Telephone | 831-475-4024
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Fax | 831-475-4344
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Provider Business Mailing Address
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Address Line | 4140 JADE STREET SUITE 100
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City | CAPITOLA
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State | CA
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Zip | 95010-3901
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Country | US
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Telephone | 831-475-4024
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Fax | 831-475-4344
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. NICHOLAS ASHAN ABIDI
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Credential | MD
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Telephone | 831-475-4024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G85551
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License Number State | CA
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