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General NPI Number Information
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NPI Number | 1174055693
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Entity Type | Individual
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Provider Name | DEREK L PASSER M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 3626 RUFFIN RD
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City | SAN DIEGO
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State | CA
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Zip | 92123-1810
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Country | US
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Telephone | 858-565-9666
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Fax | 858-565-9441
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Provider Business Mailing Address
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Address Line | 3626 RUFFIN RD
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City | SAN DIEGO
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State | CA
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Zip | 92123-1810
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Country | US
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Telephone | 858-565-9666
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Fax | 858-565-9441
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD61505577
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 101829
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A182607
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | DR.0065803
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License Number State | CO
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