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General NPI Number Information
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NPI Number | 1487711222
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Entity Type | Organization
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Legal Business Name | SAN DIEGO SPORTS MEDICINE & ORTHOPAEDIC CENTER
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 6719 ALVARADO RD SUITE 200
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City | SAN DIEGO
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State | CA
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Zip | 92120-5270
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Country | US
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Telephone | 619-229-3932
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Fax | 619-582-2860
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Provider Business Mailing Address
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Address Line | 6719 ALVARADO RD SUITE 200
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City | SAN DIEGO
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State | CA
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Zip | 92120-5270
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Country | US
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Telephone | 619-229-3932
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Fax | 619-582-2860
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Authorized Official
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Title or Position | BUSINESS PARTNER
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Name | DR. JAMES P. TASTO
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Credential | M.D.
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Telephone | 619-229-3932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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