Healthcare Provider Details

I. General information

NPI: 1205959574
Provider Name (Legal Business Name): SCRIPPS CLINIC MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE SUITE 600
LA JOLLA CA
92037-1224
US

IV. Provider business mailing address

FILE # 54433
LOS ANGELES CA
90074-4433
US

V. Phone/Fax

Practice location:
  • Phone: 858-453-0753
  • Fax: 858-552-6885
Mailing address:
  • Phone: 858-784-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD ROTHBERGER
Title or Position: CORPORATE EXECUTIVE VP / CFO
Credential:
Phone: 858-678-7288