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Organization
NORTHERN CALIFORNIA ORTHOPEDIC CENTERS MEDICAL GROUP
Active
Organization
NORTHERN CALIFORNIA ORTHOPEDIC CENTERS MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BREANA WELLS (EXECUTIVE DIRECTOR)
(916) 965-4000
Entity
Organization
Contact information
Practice address
6620 COYLE AVE STE 303, CARMICHAEL, CA 95608-6337
(916) 965-4000
(916) 965-4813
Mailing address
6620 COYLE AVE STE 303, CARMICHAEL, CA 95608-6337
(916) 965-4000
(916) 965-4813
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
NULL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
207XX0801X
Orthopaedic Trauma Physician
—
NULL
207XX0801X
Orthopaedic Trauma Physician
—
—
213E00000X
Podiatrist
—
CA
363A00000X
Physician Assistant
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0063680
MEDICAL GROUP NUMBER
CA
Enumeration date
05/17/2006
Last updated
10/26/2021
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