1942261599 NPI number — SDOSC, LP

Table of content: (NPI 1942261599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942261599 NPI number — SDOSC, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SDOSC, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAN DIEGO OUTPATIENT AMBULATORY SURGICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942261599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3939 RUFFIN RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-1804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-299-9530
Provider Business Mailing Address Fax Number:
619-299-3259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3939 RUFFIN RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-299-9530
Provider Business Practice Location Address Fax Number:
619-299-3259
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOERSTER
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
OWNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
619-299-9530

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  090000114 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZH3742Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZT11824G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051012 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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