Provider Demographics
NPI:1093791543
Name:SCRIPPS CLINIC MEDICAL GROUP
Entity Type:Organization
Organization Name:SCRIPPS CLINIC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:SARNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-554-8862
Mailing Address - Street 1:FILE# 54433
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:858-784-5906
Mailing Address - Fax:858-784-5922
Practice Address - Street 1:6719 ALVARADO RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5270
Practice Address - Country:US
Practice Address - Phone:619-266-4800
Practice Address - Fax:858-784-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ62359ZOtherBLUE SHIELD OF CALIFORNIA
CAW7168Medicare ID - Type Unspecified