Provider Demographics
NPI:1245216928
Name:SCRIPPS HEALTH
Entity type:Organization
Organization Name:SCRIPPS HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE EXECUTIVE VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:TANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-678-6828
Mailing Address - Street 1:10790 RANCHO BERNARDO RD.
Mailing Address - Street 2:MAIL DROP 4S-205
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-764-3000
Mailing Address - Fax:
Practice Address - Street 1:3811 VALLEY CENTRE DR.
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3318
Practice Address - Country:US
Practice Address - Phone:858-764-3000
Practice Address - Fax:858-784-5933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCRIPPS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-15
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
690009485OtherRAILROAD MEDICARE
ZZZH3751ZOtherBLUE SHIELD OF CALIFORNIA
S051719Medicare PIN