Provider Demographics
NPI:1215979547
Name:LENIHAN SELECKY ORTHOPAEDICS
Entity type:Organization
Organization Name:LENIHAN SELECKY ORTHOPAEDICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SELECKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-421-3400
Mailing Address - Street 1:955 LANE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3501
Mailing Address - Country:US
Mailing Address - Phone:619-421-3400
Mailing Address - Fax:619-421-3557
Practice Address - Street 1:955 LANE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3501
Practice Address - Country:US
Practice Address - Phone:619-421-3400
Practice Address - Fax:619-421-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3916610001Medicare NSC
CAW14404Medicare ID - Type Unspecified