Provider Demographics
NPI:1891017729
Name:UC SAN DIEGO DEPARTMENT OF ANESTHESIOLOGY
Entity Type:Organization
Organization Name:UC SAN DIEGO DEPARTMENT OF ANESTHESIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANECKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-471-0670
Mailing Address - Street 1:701 KETTNER BLVD
Mailing Address - Street 2:UNIT 202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5908
Mailing Address - Country:US
Mailing Address - Phone:802-324-1399
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DRIVE, #0801
Practice Address - Street 2:UCSD DEPT OF ANESTHESIOLOGY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:802-324-1399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ282N00000X
CAA117918282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital