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General NPI Number Information
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NPI Number | 1053375766
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Entity Type | Individual
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Provider Name | JERRY HAPPY THRUSH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 2204 GARNET AVE STE 209C
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City | SAN DIEGO
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State | CA
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Zip | 92109-3771
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Country | US
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Telephone | 949-439-0455
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Fax | 619-292-0584
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Provider Business Mailing Address
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Address Line | 4231 BALBOA AVE # 302
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City | SAN DIEGO
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State | CA
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Zip | 92117-5504
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Country | US
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Telephone | 949-439-0455
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Fax | 619-292-0584
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G66280
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License Number State | CA
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