Healthcare Provider Details

I. General information

NPI: 1619910411
Provider Name (Legal Business Name): MICHAEL SCOT PRICE P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 440
LA JOLLA CA
92037-1224
US

IV. Provider business mailing address

PO BOX 33865
SAN DIEGO CA
92163-3865
US

V. Phone/Fax

Practice location:
  • Phone: 858-453-5944
  • Fax: 858-552-2182
Mailing address:
  • Phone: 858-888-7700
  • Fax: 858-888-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number00080687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: