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General NPI Number Information
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NPI Number | 1134713704
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Entity Type | Organization
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Legal Business Name | PRESTIGE ORTHOPAEDICS AND SPORTS MEDICINE, INC.
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 11939 RANCHO BERNARDO RD STE 115
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City | SAN DIEGO
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State | CA
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Zip | 92128-2073
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Country | US
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Telephone | 858-705-6130
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Fax | 858-400-4080
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Provider Business Mailing Address
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Address Line | 11939 RANCHO BERNARDO RD STE 115
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City | SAN DIEGO
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State | CA
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Zip | 92128-2073
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Country | US
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Telephone | 858-705-6130
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Fax | 858-400-4080
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER EDWARD URBAND
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Credential | M.D.
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Telephone | 858-705-6130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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