# ROBERT K. EASTLACK MD INC

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

## Provider details

- **NPI number:** 1821227463
- **Authorized official:** DR. ROBERT KENNETH EASTLACK M.D. (PRESIDENT/CEO)
- **Authorized official phone:** (858) 361-1390

## Contact information

- **Practice address:** 5265 AMBER VIEW PT, SAN DIEGO, CA 92130-6933
- **Practice address phone:** (858) 361-1390
- **Practice address fax:** (858) 925-7227
- **Mailing address:** 5265 AMBER VIEW PT, SAN DIEGO, CA 92130-6933
- **Mailing address phone:** (858) 361-1390
- **Mailing address fax:** (858) 925-7227

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | A73162 | CA | Yes |

## Other

- **Enumeration date:** 07/03/2009
- **Last updated:** 07/03/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 093411900 | — | MN |