Provider Demographics
NPI:1730114497
Name:SCLAR, CRAIG M (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:M
Last Name:SCLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 710488
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92171-0488
Mailing Address - Country:US
Mailing Address - Phone:858-268-1111
Mailing Address - Fax:858-268-0761
Practice Address - Street 1:3880 MURPHY CANYON RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4411
Practice Address - Country:US
Practice Address - Phone:858-268-1111
Practice Address - Fax:858-268-0761
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A36023Medicaid
A36023Medicare PIN
CA00A36023Medicaid
CAA84845Medicare UPIN