Healthcare Provider Details

I. General information

NPI: 1366221350
Provider Name (Legal Business Name): PRECISION ORTHOPEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 POMERADO RD STE E6
POWAY CA
92064-2427
US

IV. Provider business mailing address

1230 S CAMDEN DR
LOS ANGELES CA
90035-1112
US

V. Phone/Fax

Practice location:
  • Phone: 877-806-7846
  • Fax:
Mailing address:
  • Phone: 916-382-0653
  • Fax: 916-314-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA PATRICIA ELENES
Title or Position: RCM MANAGER
Credential:
Phone: 916-382-0653