Healthcare Provider Details

I. General information

NPI: 1487635272
Provider Name (Legal Business Name): ANDREW J SKALSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

3860 CALLE FORTUNADA STE #210
SAN DIEGO CA
92123-4802
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-8974
  • Fax: 858-966-6721
Mailing address:
  • Phone: 858-309-6303
  • Fax: 858-309-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA90003
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA90003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: