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General NPI Number Information
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NPI Number | 1215343264
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Entity Type | Organization
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Legal Business Name | SILVERGATE MEDICAL CORP.
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 16769 BERNARDO CENTER DR SUITE K13
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City | SAN DIEGO
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State | CA
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Zip | 92128-2546
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Country | US
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Telephone | 760-990-3523
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27437
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City | SAN DIEGO
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State | CA
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Zip | 92198-1437
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Country | US
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Telephone | 760-990-3523
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. EDIT E. HEGYI
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Credential | M.D, PHD
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Telephone | 760-522-1360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A89002
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License Number State | CA
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