Healthcare Provider Details

I. General information

NPI: 1760422992
Provider Name (Legal Business Name): DAVID H BROIDE MB CHB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCSD PERLMAN CLINIC 9350 CAMPUS POINT
LA JOLLA CA
92037
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-8322
  • Fax: 858-534-2110
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA38964
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA38964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: