Provider Demographics
NPI:1275567448
Name:SCRIPPS HEALTH
Entity Type:Organization
Organization Name:SCRIPPS HEALTH
Other - Org Name:SCRIPPS MEDICAL FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE EXECUTIVE VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROTHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-678-7268
Mailing Address - Street 1:PO BOX 51066
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5366
Mailing Address - Country:US
Mailing Address - Phone:760-806-5500
Mailing Address - Fax:
Practice Address - Street 1:4318 MISSION AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6541
Practice Address - Country:US
Practice Address - Phone:760-901-5100
Practice Address - Fax:760-945-3284
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCRIPPS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207PE0005X
CAA45736207QG0300X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
No209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14616Medicare UPIN
CAW14616Medicare UPIN
CA00A457360Medicaid