MEDICARE: CUTTING EDGE ORTHOPEDICS 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	A116351	CA

General Provider Information

NPI Number	:	1922534445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUTTING EDGE ORTHOPEDICS INC

Provider Business Mailing Address
First Line	:	1717 E VISTA CHINO STE A7-492
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-3559
Country	:	US
Telephone Number	:	760-360-6784
Fax Number	:

Provider Business Practice Location Address
First Line	:	74000 COUNTRY CLUB DR
Second Line	:	SUITE G3
City	:	PALM DESERT
State	:	CA
Zip	:	92260-1685
Country	:	US
Telephone Number	:	760-360-6784
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SYDNEY PARDINO
Credential	:	MD
Telephone Number	:	760-360-6784

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	05/03/2017

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