Provider Demographics
NPI:1356433965
Name:SAN DIEGUITO ORTHOPEDIC MEDICAL CENTER P C
Entity type:Organization
Organization Name:SAN DIEGUITO ORTHOPEDIC MEDICAL CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:GELB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-943-6700
Mailing Address - Street 1:332 SANTA FE DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024
Mailing Address - Country:US
Mailing Address - Phone:760-943-6700
Mailing Address - Fax:760-632-4292
Practice Address - Street 1:332 SANTA FE DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-943-6700
Practice Address - Fax:760-632-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0093170Medicaid
CAZZZ04918ZOtherBLUE SHIELD
CAGR0093170Medicaid
CAW15788Medicare PIN