Healthcare Provider Details

I. General information

NPI: 1801060843
Provider Name (Legal Business Name): JEROME ALCALA SIGUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CAMINO DEL RIO S
SAN DIEGO CA
92108-3812
US

IV. Provider business mailing address

3110 CAMINO DEL RIO S
SAN DIEGO CA
92108-3812
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax:
Mailing address:
  • Phone: 858-552-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55507
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 119989
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: