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
—
—
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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