Individual
MARK T SELECKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
955 LANE AVE, SUITE 200, CHULA VISTA, CA 91914-3501
(619) 421-3400
(619) 421-3557
Mailing address
955 LANE AVE, SUITE 200, CHULA VISTA, CA 91914-3501
(619) 421-3400
(619) 421-3557
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
G78136
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G781360
—
CA
Enumeration date
06/12/2006
Last updated
06/07/2022
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