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General NPI Number Information
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NPI Number | 1215261136
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Entity Type | Organization
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Legal Business Name | BAY AREA ORTHOPAEDIC SPORTS & SPINE, INC
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 09/24/2009
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Provider Practice Location Address
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Address Line | 5915 HOLLIS ST STE B
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City | EMERYVILLE
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State | CA
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Zip | 94608-2066
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Country | US
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Telephone | 510-547-5633
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Fax | 510-547-3049
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Provider Business Mailing Address
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Address Line | 5915 HOLLIS ST STE B
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City | EMERYVILLE
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State | CA
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Zip | 94608-2066
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Country | US
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Telephone | 510-547-5633
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Fax | 510-547-3049
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. CAROLYN E SANTEE
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Credential |
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Telephone | 510-547-5633
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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 | FNP 32759
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License Number State | CA
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