Healthcare Provider Details

I. General information

NPI: 1407829773
Provider Name (Legal Business Name): LA JOLLA ENDOSCOPY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE SUITE 980
LA JOLLA CA
92037-1234
US

IV. Provider business mailing address

9850 GENESEE AVE SUITE 980
LA JOLLA CA
92037-1234
US

V. Phone/Fax

Practice location:
  • Phone: 858-453-7525
  • Fax: 858-453-5753
Mailing address:
  • Phone: 858-453-7525
  • Fax: 858-453-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number080000443
License Number StateCA

VIII. Authorized Official

Name: MR. JEFFREY SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283