Provider Demographics
NPI:1205959574
Name:SCRIPPS CLINIC MEDICAL GROUP, INC
Entity type:Organization
Organization Name:SCRIPPS CLINIC MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE EXECUTIVE VP / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-678-7288
Mailing Address - Street 1:FILE # 54433
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-4433
Mailing Address - Country:US
Mailing Address - Phone:858-784-5888
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-453-0753
Practice Address - Fax:858-552-6885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCRIPPS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7168Medicare PIN