Provider Demographics
NPI:1700982741
Name:ORTHOPEDIC MEDICAL GROUP OF SAN DIEGO, INC.
Entity Type:Organization
Organization Name:ORTHOPEDIC MEDICAL GROUP OF SAN DIEGO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:SANTORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-278-8300
Mailing Address - Street 1:3750 CONVOY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3738
Mailing Address - Country:US
Mailing Address - Phone:858-278-8300
Mailing Address - Fax:858-278-1708
Practice Address - Street 1:3750 CONVOY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3738
Practice Address - Country:US
Practice Address - Phone:858-278-8300
Practice Address - Fax:858-278-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty