MEDICARE: ORTHOPEDIC MEDICAL GROUP OF SAN DIEGO, INC.

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	:	1700982741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC MEDICAL GROUP OF SAN DIEGO, INC.

Provider Business Mailing Address
First Line	:	3750 CONVOY ST
Second Line	:	SUITE 201
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-3738
Country	:	US
Telephone Number	:	858-278-8300
Fax Number	:	858-278-1708

Provider Business Practice Location Address
First Line	:	3750 CONVOY ST
Second Line	:	SUITE 201
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-3738
Country	:	US
Telephone Number	:	858-278-8300
Fax Number	:	858-278-1708

Authorized Official
Title or Position	:	CEO/CFO
Name	:	DR. RICHARD F. SANTORE
Credential	:	M.D.
Telephone Number	:	858-278-8300

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	02/04/2014

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