Healthcare Provider Details

I. General information

NPI: 1114060126
Provider Name (Legal Business Name): MARK RECHNIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 GIRARD AVE STE 204
LA JOLLA CA
92037-5138
US

IV. Provider business mailing address

7300 GIRARD AVE STE 204
LA JOLLA CA
92037-5138
US

V. Phone/Fax

Practice location:
  • Phone: 858-587-9970
  • Fax: 858-587-2867
Mailing address:
  • Phone: 858-587-9970
  • Fax: 858-587-2867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberG42815
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG42815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: