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General NPI Number Information
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NPI Number | 1902281827
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Entity Type | Organization
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Legal Business Name | OLYMPUS ORTHOPEDIC MEDICAL GROUP INC
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 3750 CONVOY ST SUITE 201
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City | SAN DIEGO
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State | CA
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Zip | 92111-3738
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Country | US
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Telephone | 858-278-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 CONVOY ST SUITE 201
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City | SAN DIEGO
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State | CA
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Zip | 92111-3738
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Country | US
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Telephone | 858-300-2260
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Fax |
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Authorized Official
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Title or Position | OWNER/SURGEON
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Name | DR. OKECHUKWU ANAKWENZE
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Credential | MD
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Telephone | 858-300-2260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | A126807
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License Number State | CA
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