Healthcare Provider Details

I. General information

NPI: 1760758718
Provider Name (Legal Business Name): SUTTON CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7866 ROSELAND DR
LA JOLLA CA
92037-4016
US

IV. Provider business mailing address

7866 ROSELAND DR
LA JOLLA CA
92037-4016
US

V. Phone/Fax

Practice location:
  • Phone: 858-454-5537
  • Fax:
Mailing address:
  • Phone: 858-454-5537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License NumberC36669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: