Individual
DR. MARK JOHN GHILARDUCCI
Active
Individual
DR. MARK JOHN GHILARDUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
G59002
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
G59002
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E65590
UPIN
CA
01
—
G59002
STATE LICENSE
CA
Enumeration date
04/18/2006
Last updated
07/14/2025
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