=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487553962
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCELL ORTHO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2026
-----------------------------------------------------
Last Update Date | 11/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5643 COPLEY DR STE 300
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92111-7903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-698-0651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 17052
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92177-7052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-698-0651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MR. BRIAN RATAJCZAK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-698-0651
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------