1750739116 NPI number — UC SAN DIEGO HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750739116 NPI number — UC SAN DIEGO HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UC SAN DIEGO HEALTH
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:
Provider Other Organization Name Type Code:
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:
1750739116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9500 GILMAN DR
Provider Second Line Business Mailing Address:
9116A
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92093-5004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-534-4040
Provider Business Mailing Address Fax Number:
858-822-0231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9500 GILMAN DR
Provider Second Line Business Practice Location Address:
9116A
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92093-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-534-4040
Provider Business Practice Location Address Fax Number:
858-822-0231
Provider Enumeration Date:
05/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
RILEY
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
RESIDENCY CORDINATOR
Authorized Official Telephone Number:
858-534-4040

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , 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)





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