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General NPI Number Information
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NPI Number | 1184519852
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Entity Type | Organization
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Legal Business Name | ORTHOLIVE MEDICAL GROUP - CA PC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 166 GEARY ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-5631
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Country | US
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Telephone | 866-456-7846
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Fax | 513-306-4004
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Provider Business Mailing Address
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Address Line | 1311 VINE ST
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City | CINCINNATI
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State | OH
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Zip | 45202-7118
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Country | US
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Telephone | 866-456-7846
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Fax | 513-306-4004
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Authorized Official
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Title or Position | COO
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Name | MARK G DIMARE
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Credential |
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Telephone | 561-758-7641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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