Basic Information
| Provider Information | |||||||||
| NPI: | 1649409905 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPORTS ORTHOPEDIC AND REHABILITATION MEDICINE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 S WINCHESTER BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951282544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082474900 | ||||||||
| FaxNumber: | 6509951202 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 S WINCHESTER BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951282544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082474900 | ||||||||
| FaxNumber: | 6509951202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2009 | ||||||||
| LastUpdateDate: | 11/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | SOLLAR | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF ADMINISTRATIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6508514900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.