Healthcare Provider Details

I. General information

NPI: 1972503233
Provider Name (Legal Business Name): LA JOLLA ORTHOPAEDIC SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 LA JOLLA VILLAGE DR
LA JOLLA CA
92037-1406
US

IV. Provider business mailing address

4120 LA JOLLA VILLAGE DR
LA JOLLA CA
92037-1406
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-0055
  • Fax: 858-657-0066
Mailing address:
  • Phone: 858-657-0055
  • Fax: 858-657-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number080000653
License Number StateCA

VIII. Authorized Official

Name: MRS. JENNA PON KIRKPATRICK
Title or Position: ADMINISTRATOR
Credential:
Phone: 858-657-0055