Provider Demographics
NPI:1467903682
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:STAFF PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-822-6094
Mailing Address - Street 1:3855 HEALTH SCIENCES DR
Mailing Address - Street 2:SUITE 1036
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0845
Mailing Address - Country:US
Mailing Address - Phone:858-822-6094
Mailing Address - Fax:
Practice Address - Street 1:3855 HEALTH SCIENCES DR
Practice Address - Street 2:SUITE 1036
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0845
Practice Address - Country:US
Practice Address - Phone:858-822-6094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 45278261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center