Basic Information
| Provider Information | |||||||||
| NPI: | 1811208226 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCRIPPS HEALTH | ||||||||
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| OtherOrganizationName: | SCRIPPS MEDICAL FOUNDATION/SCMC DEL MAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 51066 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900515366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585549100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1335 CAMINO DEL MAR | ||||||||
| Address2: | |||||||||
| City: | DEL MAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920142507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585549100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2010 | ||||||||
| LastUpdateDate: | 08/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | ROTHBERGER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 8586786828 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.