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General NPI Number Information
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NPI Number | 1285702654
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Entity Type | Organization
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Legal Business Name | SCRIPPS RANCH MEDICAL CLINIC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 9999 MIRA MESA BLVD STE 104
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City | SAN DIEGO
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State | CA
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Zip | 92131-1006
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Country | US
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Telephone | 858-271-6962
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Fax | 858-271-5327
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Provider Business Mailing Address
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Address Line | 9999 MIRA MESA BLVD STE 104
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City | SAN DIEGO
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State | CA
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Zip | 92131-1006
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Country | US
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Telephone | 858-271-6962
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Fax | 858-271-5327
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Authorized Official
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Title or Position | GEN PTR/MEDICAL DIRECTOR
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Name | DR. JACK WASSERMAN
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Credential | M.D.
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Telephone | 858-271-6962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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