MEDICARE: DR. SAMUEL A BOZZETTE MD, PHD

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	207RI0200X	Infectious Disease Physician	G51970	CA

General Provider Information

NPI Number	:	1992893929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL A BOZZETTE MD, PHD

Provider Business Mailing Address
First Line	:	700 W HARBOR DR
Second Line	:	UNIT 1201
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-7753
Country	:	US
Telephone Number	:	619-920-4543
Fax Number	:	619-255-9500

Provider Business Practice Location Address
First Line	:	700 W HARBOR DR
Second Line	:	UNIT 1201
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-7753
Country	:	US
Telephone Number	:	619-920-4543
Fax Number	:	619-255-9500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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