# MISSION PEAK ORTHOPAEDIC MEDICAL GROUP INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326394974
- **Authorized official:** LINGAGOUD MEMULA (ADMINISTRATOR)
- **Authorized official phone:** (510) 818-2011

## Contact information

- **Practice address:** 27206 CALAROGA AVE, SUITE 107, HAYWARD, CA 94545-4300
- **Practice address phone:** (510) 300-9898
- **Practice address fax:** (510) 797-5184
- **Mailing address:** 39350 CIVIC CENTER DR STE 300, FREMONT, CA 94538-2331
- **Mailing address phone:** (510) 797-3933
- **Mailing address fax:** (510) 797-5184

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | — |

## Other

- **Enumeration date:** 08/01/2012
- **Last updated:** 12/23/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | ZZZ5427Z | BLUE SHIELD | CA |