Provider Demographics
NPI:1023141686
Name:SCRIPPS HEALTH DBA SCRIPPS MEDICAL FOUNDATION
Entity type:Organization
Organization Name:SCRIPPS HEALTH DBA SCRIPPS MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:KISHABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-278-3301
Mailing Address - Street 1:501 WASHINGTON ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2231
Mailing Address - Country:US
Mailing Address - Phone:619-278-3300
Mailing Address - Fax:619-278-3310
Practice Address - Street 1:501 WASHINGTON ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2231
Practice Address - Country:US
Practice Address - Phone:619-278-3300
Practice Address - Fax:619-278-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty