Provider Demographics
NPI:1356505705
Name:POMERANTZ, MICHAEL LUCIUS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LUCIUS
Last Name:POMERANTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:955 LANE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4525
Mailing Address - Country:US
Mailing Address - Phone:619-421-3400
Mailing Address - Fax:619-421-3557
Practice Address - Street 1:4445 EASTGATE MALL STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:619-421-3400
Practice Address - Fax:619-421-3557
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60918207X00000X
CAA109105207XS0106X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery