Healthcare Provider Details

I. General information

NPI: 1780669473
Provider Name (Legal Business Name): SCRIPPS CLINIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9894 GENESEE AVE
LA JOLLA CA
92037-1205
US

IV. Provider business mailing address

FILE#54433
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 858-626-5663
  • Fax: 858-784-5922
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT B. SARNOFF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-554-8862