Provider Demographics
NPI:1982749586
Name:TORREY PINES ORTHOPAEDIC MEDICAL GROUP INC
Entity Type:Organization
Organization Name:TORREY PINES ORTHOPAEDIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT TPOMG
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:THUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-535-1075
Mailing Address - Street 1:12865 POINTE DEL MAR WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3860
Mailing Address - Country:US
Mailing Address - Phone:858-535-1894
Mailing Address - Fax:858-953-9810
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-535-1075
Practice Address - Fax:858-453-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29014207X00000X
CAG24499207X00000X
CA207X00000X
CAA43071207XS0106X
CAG47541207XS0114X
CAA72768207XS0117X
CAA96167207XX0004X
CAG75801207XX0005X
CAG54652207XX0005X
2251X0800X
CAPT297812251X0800X
CAPT346182251X0800X
CAPT297822251X0800X
CAPT207672251X0800X
CAOT2588225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT20767DOtherPPIN
WPT20767DOtherPPIN
PT20767Medicare UPIN
W15730AMedicare ID - Type Unspecified