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NPI Code Detail

MEDICARE: SCRIPPS CLINIC MEDICAL GROUP, INC

MEDICARE: SCRIPPS CLINIC MEDICAL GROUP, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology PhysicianG66352CA

General Provider Information

NPI Number : 1073853180
Entity Type Code : Organization
Provider Name (Legal Business Name) : SCRIPPS CLINIC MEDICAL GROUP, INC
Provider Business Mailing Address
First Line : 9730 SUMMERS RIDGE RD
Second Line : PTC-100
City : SAN DIEGO
State : CA
Zip : 92121-3101
Country : US
Telephone Number : 858-549-7400
Fax Number :
Provider Business Practice Location Address
First Line : 9730 SUMMERS RIDGE RD
Second Line : PTC-100
City : SAN DIEGO
State : CA
Zip : 92121-3101
Country : US
Telephone Number : 858-549-7400
Fax Number :
Authorized Official
Title or Position : SENIOR VICE PRESIDENT
Name : MR. JAMES MULVEY
Credential :
Telephone Number : 858-554-8500
Provider Enumeration Date : 02/26/2013
Last Update Date : 02/26/2013

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