Healthcare Provider Details

I. General information

NPI: 1225648470
Provider Name (Legal Business Name): UCSD AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 LA JOLLA VILLAGE DR
LA JOLLA CA
92037-1406
US

IV. Provider business mailing address

4120 LA JOLLA VILLAGE DR
LA JOLLA CA
92037-1406
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-0055
  • Fax: 858-657-0066
Mailing address:
  • Phone: 858-657-0055
  • Fax: 858-657-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JEREMY PEOPLES
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 858-657-0055