Basic Information
| Provider Information | |||||||||
| NPI: | 1841379831 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA SPORTS AND ORTHOPAEDIC INSTITUTE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2999 REGENT ST | ||||||||
| Address2: | STE 225 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107047760 | ||||||||
| FaxNumber: | 5107047765 | ||||||||
| Practice Location | |||||||||
| Address1: | 2999 REGENT ST | ||||||||
| Address2: | STE 225 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107047760 | ||||||||
| FaxNumber: | 5107047765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 02/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | EPPLEY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5107047760 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0010X | A67022 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 208100000X | PT25357 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | PT21053 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 363AS0400X | PA15294 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 207X00000X | A78633 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | G63226 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | ZZZ64579Z | 01 | CA | GROUP NUMBER | OTHER |