Healthcare Provider Details

I. General information

NPI: 1457074635
Provider Name (Legal Business Name): SYNERGY ORTHOPEDIC SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR STE 256
LA MESA CA
91942-3098
US

IV. Provider business mailing address

4445 EASTGATE MALL STE 105
SAN DIEGO CA
92121-1979
US

V. Phone/Fax

Practice location:
  • Phone: 619-421-3400
  • Fax:
Mailing address:
  • Phone: 185-877-5926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: TAL DAVID
Title or Position: PRESIDENT
Credential:
Phone: 858-412-6080