Healthcare Provider Details

I. General information

NPI: 1306212550
Provider Name (Legal Business Name): UCSD PHYSICIANS NETWORK - SPECIALTY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9339 GENESEE AVE SUITE 220
SAN DIEGO CA
92121-2119
US

IV. Provider business mailing address

9339 GENESEE AVE SUITE 220
SAN DIEGO CA
92121-2119
US

V. Phone/Fax

Practice location:
  • Phone: 858-455-7520
  • Fax: 858-554-1312
Mailing address:
  • Phone: 858-455-7520
  • Fax: 858-554-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN DUNCAN CAMPBELL
Title or Position: EXECUTIVE OFFICER
Credential:
Phone: 619-543-3982