Healthcare Provider Details

I. General information

NPI: 1265139430
Provider Name (Legal Business Name): SYNERGY ORTHOPEDIC SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6719 ALVARADO RD STE 200
SAN DIEGO CA
92120-5256
US

IV. Provider business mailing address

4445 EASTGATE MALL STE 105
SAN DIEGO CA
92121-1979
US

V. Phone/Fax

Practice location:
  • Phone: 619-229-3932
  • Fax:
Mailing address:
  • Phone: 858-412-6080
  • Fax:

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 Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: TAL DAVID
Title or Position: PRESIDENT
Credential:
Phone: 858-412-6080