Healthcare Provider Details

I. General information

NPI: 1437170693
Provider Name (Legal Business Name): JOSEPH RESNIKOFF, M.D., F.C.C.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 3RD AVE STE 300
SAN DIEGO CA
92103-2138
US

IV. Provider business mailing address

4033 3RD AVE STE 300
SAN DIEGO CA
92103-2138
US

V. Phone/Fax

Practice location:
  • Phone: 619-299-2570
  • Fax: 619-294-2738
Mailing address:
  • Phone: 619-299-2570
  • Fax: 619-294-2738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG81283
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG81283
License Number StateCA

VIII. Authorized Official

Name: MELISSA SUE MILLER
Title or Position: MEDICAL BILLER
Credential:
Phone: 619-299-2570