Provider Demographics
NPI:1407829773
Name:LA JOLLA ENDOSCOPY CENTER LP
Entity Type:Organization
Organization Name:LA JOLLA ENDOSCOPY CENTER LP
Other - Org Name:LA JOLLA ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 980
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1234
Mailing Address - Country:US
Mailing Address - Phone:858-453-7525
Mailing Address - Fax:858-453-5753
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 980
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1234
Practice Address - Country:US
Practice Address - Phone:858-453-7525
Practice Address - Fax:858-453-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000443261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5329026Medicaid
CA5329026Medicaid
CA490005303Medicare PIN
CA5329026Medicaid