Healthcare Provider Details

I. General information

NPI: 1275602625
Provider Name (Legal Business Name): ANTHONY DAVID PUOPOLO II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FIR ST
SAN DIEGO CA
92101-2327
US

IV. Provider business mailing address

300 FIR ST
SAN DIEGO CA
92101-2327
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2777
  • Fax: 619-557-2770
Mailing address:
  • Phone: 858-499-2777
  • Fax: 619-557-2770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA104552
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA104552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: