Healthcare Provider Details

I. General information

NPI: 1952560740
Provider Name (Legal Business Name): SK CLLINIC SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 NAUTILUS ST
LA JOLLA CA
92037-6138
US

IV. Provider business mailing address

528 NAUTILUS ST
LA JOLLA CA
92037-6138
US

V. Phone/Fax

Practice location:
  • Phone: 858-454-3161
  • Fax: 858-454-0790
Mailing address:
  • Phone: 858-454-3161
  • Fax: 858-454-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberG029780
License Number StateCA

VIII. Authorized Official

Name: MRS. KAREN F BREMSETH
Title or Position: INSURANCE BILLER
Credential:
Phone: 858-454-3161