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General NPI Number Information
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NPI Number | 1326394974
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Entity Type | Organization
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Legal Business Name | MISSION PEAK ORTHOPAEDIC MEDICAL GROUP INC.
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 12/23/2013
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Provider Practice Location Address
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Address Line | 27206 CALAROGA AVE SUITE 107
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City | HAYWARD
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State | CA
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Zip | 94545-4300
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Country | US
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Telephone | 510-300-9898
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Fax | 510-797-5184
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Provider Business Mailing Address
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Address Line | 39350 CIVIC CENTER DR STE 300
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City | FREMONT
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State | CA
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Zip | 94538-2331
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Country | US
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Telephone | 510-797-3933
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Fax | 510-797-5184
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LINGAGOUD MEMULA
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Credential |
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Telephone | 510-818-2011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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