Healthcare Provider Details

I. General information

NPI: 1629088059
Provider Name (Legal Business Name): HENRY G. INGERSOLL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 03/01/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 VIA LADETA
LA JOLLA CA
92037-6905
US

IV. Provider business mailing address

2043 VIA LADETA
LA JOLLA CA
92037-6905
US

V. Phone/Fax

Practice location:
  • Phone: 858-735-5970
  • Fax:
Mailing address:
  • Phone: 858-735-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG27265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: