Provider Demographics
NPI:1750720785
Name:SAN DIEGO ORTHOPEDICS
Entity type:Organization
Organization Name:SAN DIEGO ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ELGUEZABAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-422-1788
Mailing Address - Street 1:319 W. 18TH ST.
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950
Mailing Address - Country:US
Mailing Address - Phone:619-477-7075
Mailing Address - Fax:619-477-7076
Practice Address - Street 1:3136 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911
Practice Address - Country:US
Practice Address - Phone:619-422-1788
Practice Address - Fax:619-422-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50312332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies