Healthcare Provider Details

I. General information

NPI: 1790772978
Provider Name (Legal Business Name): DONALD C LIPKIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6719 ALVARADO RD 206
SAN DIEGO CA
92120-5270
US

IV. Provider business mailing address

6719 ALVARADO RD 206
SAN DIEGO CA
92120-5270
US

V. Phone/Fax

Practice location:
  • Phone: 619-287-9100
  • Fax: 619-287-4536
Mailing address:
  • Phone: 619-287-9100
  • Fax: 619-287-4536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG27123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: