MEDICARE: PACIFIC MEDICAL NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1386272631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC MEDICAL NETWORK

Provider Business Mailing Address
First Line	:	8901 ACTIVITY RD STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 ACTIVITY RD STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4436
Country	:	US
Telephone Number	:	858-703-6964
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	JOHN AUSTIN
Credential	:	MD
Telephone Number	:	858-703-6964

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	03/31/2020

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Directions to “PACIFIC MEDICAL NETWORK ” Practice Location

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