Provider Demographics
NPI:1760422992
Name:BROIDE, DAVID H (MB CHB)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:BROIDE
Suffix:
Gender:M
Credentials:MB CHB
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 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UCSD PERLMAN CLINIC
Practice Address - Street 2:9350 CAMPUS POINT
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-657-8322
Practice Address - Fax:858-534-2110
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38964207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A389640Medicaid
B97208Medicare UPIN
CAWA38964BMedicare ID - Type Unspecified