Provider Demographics
NPI:1306042668
Name:SAN DIEGO INSTITUTE FOR PREVENTION AND WELLNESS
Entity Type:Organization
Organization Name:SAN DIEGO INSTITUTE FOR PREVENTION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:PTRICE
Authorized Official - Last Name:BAXTER-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-505-9438
Mailing Address - Street 1:8008 FROST ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4205
Mailing Address - Country:US
Mailing Address - Phone:858-505-9438
Mailing Address - Fax:858-613-0373
Practice Address - Street 1:8008 FROST ST
Practice Address - Street 2:SUITE 406
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4205
Practice Address - Country:US
Practice Address - Phone:858-505-9438
Practice Address - Fax:858-613-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54625207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty