Healthcare Provider Details

I. General information

NPI: 1851437792
Provider Name (Legal Business Name): TAL DAVID, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5471 KEARNY VILLA RD. SUITE 200
SAN DIEGO CA
92123-1143
US

IV. Provider business mailing address

5471 KEARNY VILLA RD. SUITE 200
SAN DIEGO CA
92123-1143
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-9500
  • Fax: 858-715-4946
Mailing address:
  • Phone: 858-571-9500
  • Fax: 858-715-4946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA69504
License Number StateCA

VIII. Authorized Official

Name: TAL S. DAVID
Title or Position: PRESIDENT
Credential: MD
Phone: 858-571-9500