MEDICARE: SAN DIEGO ULTRASCAN MEDICAL GROUP

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
1	207RC0000X	Cardiovascular Disease Physician	G58919	CA

General Provider Information

NPI Number	:	1528260619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO ULTRASCAN MEDICAL GROUP

Provider Business Mailing Address
First Line	:	8899 UNIVERSITY CENTER LN
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8899 UNIVERSITY CENTER LN
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1013
Country	:	US
Telephone Number	:	858-558-7267
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLES MICHAEL WRIGHT
Credential	:	M.D.
Telephone Number	:	858-558-7267

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	08/22/2020

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