Healthcare Provider Details

I. General information

NPI: 1679510176
Provider Name (Legal Business Name): SHARP CHULA VISTA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 MEDICAL CENTER CT 2ND FLOOR
CHULA VISTA CA
91911-6617
US

IV. Provider business mailing address

8695 SPECTRUM CENTER BLVD
SAN DIEGO CA
92123
US

V. Phone/Fax

Practice location:
  • Phone: 619-502-4000
  • Fax: 619-502-4025
Mailing address:
  • Phone: 858-499-3025
  • Fax: 858-499-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberHSP40482
License Number StateCA

VIII. Authorized Official

Name: WILLIAM SCOTT EVANS
Title or Position: SVP CHIEF STRATEGY OFFICER & CEO
Credential:
Phone: 619-740-4648