Healthcare Provider Details

I. General information

NPI: 1750739116
Provider Name (Legal Business Name): UC SAN DIEGO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR 9116A
LA JOLLA CA
92093-5004
US

IV. Provider business mailing address

9500 GILMAN DR 9116A
LA JOLLA CA
92093-5004
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-4040
  • Fax: 858-822-0231
Mailing address:
  • Phone: 858-534-4040
  • Fax: 858-822-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. TRACY RILEY
Title or Position: RESIDENCY CORDINATOR
Credential:
Phone: 858-534-4040