Provider Demographics
NPI:1215261136
Name:BAY AREA ORTHOPAEDIC SPORTS & SPINE, INC
Entity type:Organization
Organization Name:BAY AREA ORTHOPAEDIC SPORTS & SPINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-547-5633
Mailing Address - Street 1:5915 HOLLIS ST STE B
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2066
Mailing Address - Country:US
Mailing Address - Phone:510-547-5633
Mailing Address - Fax:510-547-3049
Practice Address - Street 1:5915 HOLLIS ST STE B
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2066
Practice Address - Country:US
Practice Address - Phone:510-547-5633
Practice Address - Fax:510-547-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 32759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty