# SAN DIEGUITO ORTHOPEDIC MEDICAL CENTER P C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356433965
- **Authorized official:** ROBERT IRA GELB MD (BOARD MEMBER)
- **Authorized official phone:** (760) 943-6700

## Contact information

- **Practice address:** 332 SANTA FE DRIVE, SUITE 110, ENCINITAS, CA 92024
- **Practice address phone:** (760) 943-6700
- **Practice address fax:** (760) 632-4292
- **Mailing address:** 332 SANTA FE DRIVE, SUITE 110, ENCINITAS, CA 92024
- **Mailing address phone:** (760) 943-6700
- **Mailing address fax:** (760) 632-4292

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | NULL | — |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | — | — |
| 207XS0114X | Adult Reconstructive Orthopaedic Surgery Physician | — | NULL | — |
| 207XS0114X | Adult Reconstructive Orthopaedic Surgery Physician | — | — | — |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | NULL | — |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | — | — |
| 2086X0206X | Surgical Oncology Physician | — | NULL | — |
| 2086X0206X | Surgical Oncology Physician | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 09/29/2006
- **Last updated:** 03/17/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0093170 | — | CA |
| 01 | — | ZZZ04918Z | BLUE SHIELD | CA |