Healthcare Provider Details

I. General information

NPI: 1427259597
Provider Name (Legal Business Name): UCSD PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 CALLE FORTUNADA STE 200
SAN DIEGO CA
92123-4800
US

IV. Provider business mailing address

7910 FROST ST STE 350
SAN DIEGO CA
92123-2771
US

V. Phone/Fax

Practice location:
  • Phone: 858-636-4300
  • Fax: 858-636-4319
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRETTEN PICKERING
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 858-636-4300