Healthcare Provider Details

I. General information

NPI: 1568848224
Provider Name (Legal Business Name): TORREY PINES ORTHOPAEDIC MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 210
LA JOLLA CA
92037
US

IV. Provider business mailing address

9850 GENESEE AVE STE 210
LA JOLLA CA
92037-1224
US

V. Phone/Fax

Practice location:
  • Phone: 858-535-1075
  • Fax: 858-453-9810
Mailing address:
  • Phone: 858-535-1075
  • Fax: 858-453-9810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: RICHARD M THUNDER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-535-1075