Provider Demographics
NPI:1821112145
Name:SCRIPPS ENCINITAS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SCRIPPS ENCINITAS SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:320 SANTA FE DR
Mailing Address - Street 2:STE LL2
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5138
Mailing Address - Country:US
Mailing Address - Phone:760-632-3900
Mailing Address - Fax:760-362-3950
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:STE LL2
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-632-3900
Practice Address - Fax:760-362-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00726468OtherRAILROAD MEDICARE
CA05C0001842Medicare Oscar/Certification
CAP00726468OtherRAILROAD MEDICARE