Healthcare Provider Details

I. General information

NPI: 1851481121
Provider Name (Legal Business Name): SCRIPPS CARDIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9888 GENESEE AVE
LA JOLLA CA
92037-1205
US

IV. Provider business mailing address

9834 GENESEE AVE SUITE 300
LA JOLLA CA
92037-1223
US

V. Phone/Fax

Practice location:
  • Phone: 858-824-2900
  • Fax: 858-824-2910
Mailing address:
  • Phone: 858-824-2900
  • Fax: 858-824-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MARC K. EFFRON
Title or Position: DIRECTOR
Credential: M.D.
Phone: 858-824-2900