=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356836993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALIFORNIA ORTHOPEDICS & SPINE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2018
-----------------------------------------------------
Last Update Date | 10/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 BON AIR RD STE 129
-----------------------------------------------------
City | LARKSPUR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94939-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-924-8900
-----------------------------------------------------
Fax | 415-924-7149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 BON AIR RD
-----------------------------------------------------
City | LARKSPUR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94939-1123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-927-5300
-----------------------------------------------------
Fax | 415-927-6860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MICHAEL OECHSEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 415-927-5300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------