Basic Information
| Provider Information | |||||||||
| NPI: | 1639280597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUGAR | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 FIR ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921012327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16950 VIA TAZON | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921271607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585212350 | ||||||||
| FaxNumber: | 8585212354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 05/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | 20A5303 | CA | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00AX53030 | 05 | CA | MEDICAID |