Healthcare Provider Details

I. General information

NPI: 1306105333
Provider Name (Legal Business Name): UCSD MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

200 W ARBOR DR MAIL CODE 8765
SAN DIEGO CA
92103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-5891
  • Fax: 858-657-5890
Mailing address:
  • Phone: 619-543-6194
  • Fax: 619-543-5829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberHPE39291
License Number StateCA

VIII. Authorized Official

Name: MR. HAGNEY GARY
Title or Position: DIRECTOR,UCSD AMCARE PHARMACY
Credential: RPH
Phone: 619-543-6194