MEDICARE: PACIFIC COAST ORTHOPEDICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	A71729	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629143581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC COAST ORTHOPEDICS INC

Provider Business Mailing Address
First Line	:	19 UPPER RAGSDALE DR STE 150
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-7837
Country	:	US
Telephone Number	:	831-464-6200
Fax Number	:	831-464-6204

Provider Business Practice Location Address
First Line	:	101 WILSON RD
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-7864
Country	:	US
Telephone Number	:	831-648-8600
Fax Number	:	831-920-3400

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	RICHARD V RAVALIN
Credential	:	MD
Telephone Number	:	831-648-8600

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	08/19/2020

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Directions to “PACIFIC COAST ORTHOPEDICS INC ” Practice Location

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