Provider Demographics
NPI:1407112147
Name:UNIVERSITY OF SAN DIEGO MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF SAN DIEGO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-249-0547
Mailing Address - Street 1:249 BONAIR ST
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5974
Mailing Address - Country:US
Mailing Address - Phone:515-249-0547
Mailing Address - Fax:
Practice Address - Street 1:9500 GILMAN DR
Practice Address - Street 2:SOM BUILDING #1, ROOM 103
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-5004
Practice Address - Country:US
Practice Address - Phone:858-822-5604
Practice Address - Fax:858-822-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120237282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital