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General NPI Number Information
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NPI Number | 1912318023
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Entity Type | Organization
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Legal Business Name | MD2 LA JOLLA
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 4180 LA JOLLA VILLAGE DR STE 220
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City | LA JOLLA
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State | CA
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Zip | 92037-1471
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Country | US
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Telephone | 858-321-2150
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Fax | 858-321-2153
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Provider Business Mailing Address
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Address Line | PO BOX 92707
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City | SAN DIEGO
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State | CA
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Zip | 92707-2707
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Country | US
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Telephone | 858-729-3050
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Fax | 805-462-1032
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Authorized Official
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Title or Position | OWNER
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Name | RAMONA MASTER
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Credential | MD
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Telephone | 858-321-2150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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