Healthcare Provider Details

I. General information

NPI: 1841600806
Provider Name (Legal Business Name): UNIVERSITY OF CALIFORNIA SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 DICKINSON ST MAIL CODE 8208
SAN DIEGO CA
92103-2071
US

IV. Provider business mailing address

220 DICKINSON ST MAIL CODE 8208
SAN DIEGO CA
92103-2071
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-5238
  • Fax: 619-543-5066
Mailing address:
  • Phone: 619-543-5238
  • Fax: 619-543-5066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License NumberF36604
License Number StateCA

VIII. Authorized Official

Name: MS. JOANNE SANTANGELO
Title or Position: NPII
Credential: RN FNP-C
Phone: 619-543-5238