Healthcare Provider Details

I. General information

NPI: 1811703044
Provider Name (Legal Business Name): SAN DIEGO INFUSION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 GENESEE AVE STE 310
LA JOLLA CA
92037-1221
US

IV. Provider business mailing address

9834 GENESEE AVE STE 310
LA JOLLA CA
92037-1221
US

V. Phone/Fax

Practice location:
  • Phone: 858-457-8600
  • Fax: 858-764-9765
Mailing address:
  • Phone: 858-457-8600
  • Fax: 858-764-9765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HERMAN HOWARD MILLER II
Title or Position: OWNER
Credential:
Phone: 858-457-8600