Provider Demographics
NPI:1306047956
Name:UNIVERSITY OF CALIFORNIA, SAN DIEGO
Entity type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA, SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:858-534-2588
Mailing Address - Street 1:9500 GILMAN DRIVE #0039
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9500 GILMAN DRIVE #0039
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0039
Practice Address - Country:US
Practice Address - Phone:858-534-2588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA621284261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health