MEDICARE: WEST COUNTY ORTHOPAEDIC CLINIC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1699979831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST COUNTY ORTHOPAEDIC CLINIC

Provider Business Mailing Address
First Line	:	1660 SAN PABLO AVE
Second Line	:	SUITE A
City	:	PINOLE
State	:	CA
Zip	:	94564-2077
Country	:	US
Telephone Number	:	510-223-1430
Fax Number	:	510-223-1470

Provider Business Practice Location Address
First Line	:	1660 SAN PABLO AVE
Second Line	:	SUITE A
City	:	PINOLE
State	:	CA
Zip	:	94564-2072
Country	:	US
Telephone Number	:	510-223-1430
Fax Number	:	510-223-1470

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. VICKY MOW
Credential	:
Telephone Number	:	510-223-1430

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	11/06/2012

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Directions to “WEST COUNTY ORTHOPAEDIC CLINIC ” Practice Location

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