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General NPI Number Information
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NPI Number | 1750720785
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Entity Type | Organization
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Legal Business Name | SAN DIEGO ORTHOPEDICS
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Dates
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Enumeration Date | 06/24/2013
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Last Update Date | 06/24/2013
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Provider Practice Location Address
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Address Line | 3136 MAIN ST
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City | CHULA VISTA
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State | CA
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Zip | 91911
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Country | US
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Telephone | 619-422-1788
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Fax | 619-422-1819
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Provider Business Mailing Address
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Address Line | 319 W. 18TH ST.
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City | NATIONAL CITY
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State | CA
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Zip | 91950
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Country | US
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Telephone | 619-477-7075
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Fax | 619-477-7076
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Authorized Official
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Title or Position | OWNER
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Name | MR. BENJAMIN H ELGUEZABAL
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Credential |
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Telephone | 619-422-1788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 50312
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License Number State | CA
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