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General NPI Number Information
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NPI Number | 1346785649
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC AND SPINE INSTITUTE OF SOUTHERN CALIFORNIA, INC.
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Dates
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Enumeration Date | 12/23/2016
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Last Update Date | 05/24/2017
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Provider Practice Location Address
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Address Line | 2486 N PONDEROSA DR STE D114
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City | CAMARILLO
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State | CA
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Zip | 93010-2376
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Country | US
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Telephone | 805-484-2783
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Fax | 805-987-8519
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Provider Business Mailing Address
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Address Line | 2486 N PONDEROSA DR STE D114
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City | CAMARILLO
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State | CA
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Zip | 93010-2376
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Country | US
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Telephone | 805-484-2783
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Fax | 805-987-8519
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROCCO R CALDERONA
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Credential | MD
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Telephone | 805-484-2783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine 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 | 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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