Provider Demographics
NPI:1518991769
Name:JOHN F SHEGA A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOHN F SHEGA A PROFESSIONAL CORPORATION
Other - Org Name:ACADEMIC DERMATOLOGY CONSULTANTS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-292-7525
Mailing Address - Street 1:2710 HEALTH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2761
Mailing Address - Country:US
Mailing Address - Phone:858-292-7525
Mailing Address - Fax:
Practice Address - Street 1:2710 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2761
Practice Address - Country:US
Practice Address - Phone:858-292-7525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40700207N00000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48321Medicare UPIN
CAG40700Medicare ID - Type Unspecified