Healthcare Provider Details

I. General information

NPI: 1639694797
Provider Name (Legal Business Name): UCSD CENTER FOR SURGERY OF ENCINITAS, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL STE 100
ENCINITAS CA
92024-1328
US

IV. Provider business mailing address

477 N EL CAMINO REAL STE 100
ENCINITAS CA
92024-1328
US

V. Phone/Fax

Practice location:
  • Phone: 760-942-8800
  • Fax:
Mailing address:
  • Phone: 760-942-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDITH CAPRARO
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 661-472-7434