Healthcare Provider Details

I. General information

NPI: 1356505705
Provider Name (Legal Business Name): MICHAEL LUCIUS POMERANTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 EASTGATE MALL STE 105
SAN DIEGO CA
92121
US

IV. Provider business mailing address

955 LANE AVE SUITE 200
CHULA VISTA CA
91914-4525
US

V. Phone/Fax

Practice location:
  • Phone: 619-421-3400
  • Fax: 619-421-3557
Mailing address:
  • Phone: 619-421-3400
  • Fax: 619-421-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number60918
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA109105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: