Healthcare Provider Details

I. General information

NPI: 1487082046
Provider Name (Legal Business Name): SCRIPPS ORAL PATHOLOGY SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6727 FLANDERS DRIVE STE 101
SAN DIEGO CA
92121-2926
US

IV. Provider business mailing address

6727 FLANDERS DRIVE STE 101
SAN DIEGO CA
92121-2926
US

V. Phone/Fax

Practice location:
  • Phone: 858-784-0600
  • Fax: 858-784-0601
Mailing address:
  • Phone: 858-784-0600
  • Fax: 858-784-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. ELISAMA CHAVEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 858-784-0600