Basic Information
Provider Information | |||||||||
NPI: | 1942296058 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HELMERS | ||||||||
FirstName: | SCOTT | ||||||||
MiddleName: | WHITTAKER | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 520 J AVE | ||||||||
Address2: |   | ||||||||
City: | CORONADO | ||||||||
State: | CA | ||||||||
PostalCode: | 921181631 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6196625620 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 34800 BOB WILSON DR | ||||||||
Address2: | DEPARTMENT OF ORTHOPAEDIC SURGERY - SUITE 112 | ||||||||
City: | SAN DIEGO | ||||||||
State: | CA | ||||||||
PostalCode: | 921341098 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6195328427 | ||||||||
FaxNumber: | 6195328467 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/23/2005 | ||||||||
LastUpdateDate: | 12/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/04/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0101232591 | VA | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207X00000X | GFE72814 | CA | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
No ID Information.