Provider Demographics
NPI:1417082033
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:RESIDENCY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZISOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-534-4040
Mailing Address - Street 1:5430 LA JOLLA BLVD
Mailing Address - Street 2:#301
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7666
Mailing Address - Country:US
Mailing Address - Phone:650-315-1062
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MAIL CODE 8620
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-543-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital