Provider Demographics
NPI:1841600806
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:NPII
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:RN FNP-C
Authorized Official - Phone:619-543-5238
Mailing Address - Street 1:220 DICKINSON ST
Mailing Address - Street 2:MAIL CODE 8208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2071
Mailing Address - Country:US
Mailing Address - Phone:619-543-5238
Mailing Address - Fax:619-543-5066
Practice Address - Street 1:220 DICKINSON ST
Practice Address - Street 2:MAIL CODE 8208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2071
Practice Address - Country:US
Practice Address - Phone:619-543-5238
Practice Address - Fax:619-543-5066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF36604261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch