MEDICARE: UC SAN DIEGO FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1598155962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UC SAN DIEGO FOUNDATION

Provider Business Mailing Address
First Line	:	9500 GILMAN DR
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92093-0696
Country	:	US
Telephone Number	:	858-534-6160
Fax Number	:	858-822-3990

Provider Business Practice Location Address
First Line	:	1561 THOMAS AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4346
Country	:	US
Telephone Number	:	858-534-6160
Fax Number	:	858-822-3990

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. SUNNY D SMITH
Credential	:	MD
Telephone Number	:	858-534-6160

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	01/23/2015

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Directions to “UC SAN DIEGO FOUNDATION ” Practice Location

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