Healthcare Provider Details

I. General information

NPI: 1063769883
Provider Name (Legal Business Name): PASCUAL DUTTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 KEARNY VILLA RD STE 401
SAN DIEGO CA
92123-1964
US

IV. Provider business mailing address

9095 RIO SAN DIEGO DR STE 410
SAN DIEGO CA
92108-1679
US

V. Phone/Fax

Practice location:
  • Phone: 858-326-0890
  • Fax:
Mailing address:
  • Phone: 858-412-6080
  • Fax: 760-737-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA129631
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number129631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: