Healthcare Provider Details

I. General information

NPI: 1134713704
Provider Name (Legal Business Name): PRESTIGE ORTHOPAEDICS AND SPORTS MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11939 RANCHO BERNARDO RD STE 115
SAN DIEGO CA
92128-2073
US

IV. Provider business mailing address

11939 RANCHO BERNARDO RD STE 115
SAN DIEGO CA
92128-2073
US

V. Phone/Fax

Practice location:
  • Phone: 858-705-6130
  • Fax: 858-400-4080
Mailing address:
  • Phone: 858-705-6130
  • Fax: 858-400-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER EDWARD URBAND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-705-6130