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General NPI Number Information
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NPI Number | 1477908507
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Entity Type | Organization
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Legal Business Name | SCRIPPS PSYCHIATRIC MEDICAL GROUP
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 4077 FIFTH AVE SCRIPPS MERCY HOSPITAL
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City | SAN DIEGO
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State | CA
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Zip | 92103-2105
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Country | US
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Telephone | 619-359-6600
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Fax | 619-632-5736
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Provider Business Mailing Address
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Address Line | 550 WASHINGTON ST STE 841
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City | SAN DIEGO
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State | CA
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Zip | 92103-2232
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Country | US
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Telephone | 619-359-6600
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Fax | 619-632-5736
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURANCE DAVIS CRACROFT
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Credential | M.D.
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Telephone | 619-359-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G28587
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License Number State | CA
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