Basic Information
| Provider Information | |||||||||
| NPI: | 1417994898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UPTON | ||||||||
| FirstName: | D SCOTT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8765 AERO DRIVE | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585410181 | ||||||||
| FaxNumber: | 8584300919 | ||||||||
| Practice Location | |||||||||
| Address1: | 8765 AERO DR | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585410181 | ||||||||
| FaxNumber: | 8584300919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 11/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0010X | A84415 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 208000000X | A84415 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | A84415 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A844150 | 05 | CA | MEDICAID | DR000Z | 01 | CA | MEDICARE | OTHER |