Basic Information
| Provider Information | |||||||||
| NPI: | 1700829199 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCRIPPS HEALTH | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SCRIPPS MEMORIAL HOSPITAL ENCINITAS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 10790 RANCHO BERNARDO RD # 4S-303 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921275705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8589275328 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 354 SANTA FE DR | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920245142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604574123 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TANDE | ||||||||
| AuthorizedOfficialFirstName: | BRETT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EVP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 8586787227 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 08 0000148 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 163SHEN | 01 | CA | COUNTY MED SRVC SD | OTHER | ZZT 30503G | 05 | CA | MEDICAID | 26 | 01 | CA | KAISER | OTHER | SMEN | 01 | CA | UNIVERSAL CARE | OTHER | 6150660 | 01 | CA | AETNA | OTHER | HSC 30503G | 05 | CA | MEDICAID | ZZT 40503G | 05 | CA | MEDICAID | ZZZD0503Z | 01 | CA | BLUE SHIELD | OTHER | 050503B000000 | 01 | CA | TRAILBLAZERS 1011 | OTHER | 050503 | 01 | CA | BLUE CROSS | OTHER | HSC30503G | 01 | CA | MCL HMO IN-PATIENT | OTHER | ZZT 40503G | 01 | CA | MCL HMO OUT-PATIENT | OTHER |