Organization
MISSION ORTHOPEDICS SURGERY AND SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COLVIN CLAY WELLBORN MD (PRESIDENT)
(805) 963-3336
Entity
Organization
Contact information
Practice address
1201 E OCEAN AVE, SUITE B, LOMPOC, CA 93436-7081
(805) 963-3336
(805) 564-3332
Mailing address
PO BOX 50706, SANTA BARBARA, CA 93150-0706
(805) 963-3336
(805) 564-3332
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G846660
—
CA
Enumeration date
08/21/2006
Last updated
08/22/2020
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