MEDICARE: SHARP CHULA VISTA MEDICAL CENTER

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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)		CA

General Provider Information

NPI Number	:	1821267048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARP CHULA VISTA MEDICAL CENTER

Provider Business Mailing Address
First Line	:	8695 SPECTRUM CENTER BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1489
Country	:	US
Telephone Number	:	858-499-3025
Fax Number	:

Provider Business Practice Location Address
First Line	:	752 MEDICAL CENTER CT STE 306
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-6660
Country	:	US
Telephone Number	:	619-592-7950
Fax Number	:

Authorized Official
Title or Position	:	SVP CHIEF STRATEGY OFFICER & CEO
Name	:	WILLIAM SCOTT EVANS
Credential	:
Telephone Number	:	619-740-4648

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	06/16/2025

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Practice Location Address:

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1891957221 — JENNIFER LYNN JOTHEN D.O.
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Practice Fax:

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