Provider Demographics
NPI:1447311253
Name:ORTHOPAEDIC SPORTS SPECIALISTS A MEDICAL CORP
Entity type:Organization
Organization Name:ORTHOPAEDIC SPORTS SPECIALISTS A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JAUREGUITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-739-6520
Mailing Address - Street 1:39180 FARWELL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1000
Mailing Address - Country:US
Mailing Address - Phone:510-739-6520
Mailing Address - Fax:510-739-6522
Practice Address - Street 1:39180 FARWELL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1000
Practice Address - Country:US
Practice Address - Phone:510-739-6520
Practice Address - Fax:510-739-6522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPAEDIC SPORTS SPECIALISTS A MEDICAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81317207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089060Medicaid
BJ4100626OtherDEA
CAZZZ18646ZMedicare PIN
BJ4100626OtherDEA
CAGR0089060Medicaid