Basic Information
| Provider Information | |||||||||
| NPI: | 1205959574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCRIPPS CLINIC MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE # 54433 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900744433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8587845888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9850 GENESEE AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584530753 | ||||||||
| FaxNumber: | 8585526885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 08/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | ROTHBERGER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CORPORATE EXECUTIVE VP / CFO | ||||||||
| AuthorizedOfficialTelephone: | 8586787288 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SCRIPPS HEALTH | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.