Healthcare Provider Details

I. General information

NPI: 1831394063
Provider Name (Legal Business Name): SAN DIEGO GAMMA KNIFE CENTER, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 GENESEE AVE SUITE 110
LA JOLLA CA
92037-1223
US

IV. Provider business mailing address

9834 GENESEE AVE SUITE 110
LA JOLLA CA
92037-1223
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-5020
  • Fax: 858-452-5677
Mailing address:
  • Phone: 858-452-5020
  • Fax: 858-452-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number6072-37
License Number StateCA

VIII. Authorized Official

Name: PAUL LOFLIN JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 858-452-5020