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General NPI Number Information
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NPI Number | 1235575051
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Entity Type | Organization
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Legal Business Name | ANDERSEN ORTHOPEDICS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 913 SAN RAMON VALLEY BLVD SUITE 182
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City | DANVILLE
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State | CA
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Zip | 94526
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Country | US
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Telephone | 925-400-6900
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Fax | 925-553-7310
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Provider Business Mailing Address
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Address Line | 913 SAN RAMON VALLEY BLVD SUITE 182
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City | DANVILLE
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State | CA
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Zip | 94526
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Country | US
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Telephone | 925-400-6900
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Fax | 925-553-7310
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUCILLE B ANDERSEN
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Credential | M.D.
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Telephone | 925-400-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | C54414
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License Number State | CA
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