MEDICARE: UNIVERSITY OF CALIFORNIA SAN DIEGO

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	261QR1100X	Research Clinic/Center	F36604	CA

General Provider Information

NPI Number	:	1841600806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF CALIFORNIA SAN DIEGO

Provider Business Mailing Address
First Line	:	220 DICKINSON ST
Second Line	:	MAIL CODE 8208
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2071
Country	:	US
Telephone Number	:	619-543-5238
Fax Number	:	619-543-5066

Provider Business Practice Location Address
First Line	:	220 DICKINSON ST
Second Line	:	MAIL CODE 8208
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2071
Country	:	US
Telephone Number	:	619-543-5238
Fax Number	:	619-543-5066

Authorized Official
Title or Position	:	NPII
Name	:	MS. JOANNE SANTANGELO
Credential	:	RN FNP-C
Telephone Number	:	619-543-5238

Provider Enumeration Date	:	04/30/2014
Last Update Date	:	04/30/2014

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