Provider Demographics
NPI:1851481121
Name:SCRIPPS CARDIOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SCRIPPS CARDIOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:K
Authorized Official - Last Name:EFFRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-824-2900
Mailing Address - Street 1:9834 GENESEE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1223
Mailing Address - Country:US
Mailing Address - Phone:858-824-2900
Mailing Address - Fax:858-824-2910
Practice Address - Street 1:9888 GENESEE AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1205
Practice Address - Country:US
Practice Address - Phone:858-824-2900
Practice Address - Fax:858-824-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066150Medicaid
CAZZZ52925ZOtherBLUE SHIELD