Healthcare Provider Details

I. General information

NPI: 1114282779
Provider Name (Legal Business Name): SYNERGY ORTHOPEDIC SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9095 RIO SAN DIEGO DR STE 450
SAN DIEGO CA
92108-1726
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: 858-412-6080
  • Fax:
Mailing address:
  • Phone: 858-412-6080
  • Fax: 858-412-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN THOMAS
Title or Position: CREDENTIALING
Credential:
Phone: 858-412-6080