Healthcare Provider Details

I. General information

NPI: 1720219389
Provider Name (Legal Business Name): PEDIATRIC ORTHOPEDIC AND SCOLIOSIS CENTER OF SAN DIEGO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 CHILDRENS WAY SUITE 410
SAN DIEGO CA
92123-4232
US

IV. Provider business mailing address

3030 CHILDRENS WAY SUITE 410
SAN DIEGO CA
92123-4232
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-6789
  • Fax: 858-966-8519
Mailing address:
  • Phone: 858-966-6789
  • Fax: 858-966-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER O NEWTON
Title or Position: PRESIDENT
Credential: MD
Phone: 858-966-6789