Healthcare Provider Details

I. General information

NPI: 1174778500
Provider Name (Legal Business Name): THEODORE FRIEDMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DRIVE
LA JOLLA CA
92093-0634
US

IV. Provider business mailing address

9470 LA JOLLA SHORES DR
LA JOLLA CA
92037-1137
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-4268
  • Fax: 858-534-1422
Mailing address:
  • Phone: 858-535-9678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberG20127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: