Provider Demographics
NPI:1306212550
Name:UCSD PHYSICIANS NETWORK - SPECIALTY CARE
Entity Type:Organization
Organization Name:UCSD PHYSICIANS NETWORK - SPECIALTY CARE
Other - Org Name:UNIVERSITY OF CALIFORNIA, SAN DIEGO
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN DUNCAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-543-3982
Mailing Address - Street 1:9339 GENESEE AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2119
Mailing Address - Country:US
Mailing Address - Phone:858-455-7520
Mailing Address - Fax:858-554-1312
Practice Address - Street 1:9339 GENESEE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2119
Practice Address - Country:US
Practice Address - Phone:858-455-7520
Practice Address - Fax:858-554-1312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCSD MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty