Healthcare Provider Details

I. General information

NPI: 1194498303
Provider Name (Legal Business Name): BRIDGE PHYSICIAN NETWORK SAN DIEGO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 NOBEL DR STE 450
SAN DIEGO CA
92122-1062
US

IV. Provider business mailing address

3636 NOBEL DR STE 450
SAN DIEGO CA
92122-1062
US

V. Phone/Fax

Practice location:
  • Phone: 858-251-4242
  • Fax:
Mailing address:
  • Phone: 858-251-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SALEEM RAJPER
Title or Position: CEO & PRESIDENT
Credential: M.D.
Phone: 858-251-4242