Healthcare Provider Details

I. General information

NPI: 1366643629
Provider Name (Legal Business Name): UCSD STUDENT HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR
LA JOLLA CA
92093-0039
US

IV. Provider business mailing address

9500 GILMAN DR
LA JOLLA CA
92093-0039
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-2669
  • Fax: 858-534-6023
Mailing address:
  • Phone: 858-534-2669
  • Fax: 858-534-6023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License NumberG78529
License Number StateCA

VIII. Authorized Official

Name: BRIAN MURRAY
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 858-534-0452