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General NPI Number Information
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NPI Number | 1073853180
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Entity Type | Organization
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Legal Business Name | SCRIPPS CLINIC MEDICAL GROUP, INC
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Dates
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Enumeration Date | 02/26/2013
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 9730 SUMMERS RIDGE RD PTC-100
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City | SAN DIEGO
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State | CA
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Zip | 92121-3101
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Country | US
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Telephone | 858-549-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 9730 SUMMERS RIDGE RD PTC-100
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City | SAN DIEGO
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State | CA
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Zip | 92121-3101
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Country | US
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Telephone | 858-549-7400
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. JAMES MULVEY
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Credential |
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Telephone | 858-554-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | G66352
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License Number State | CA
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