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Organization
SCRIPPS RANCH MEDICAL CLINIC
Active
Organization
SCRIPPS RANCH MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK WASSERMAN M.D. (GEN PTR/MEDICAL DIRECTOR)
(858) 271-6962
Entity
Organization
Contact information
Practice address
9999 MIRA MESA BLVD STE 104, SAN DIEGO, CA 92131-1006
(858) 271-6962
(858) 271-5327
Mailing address
9999 MIRA MESA BLVD STE 104, SAN DIEGO, CA 92131-1006
(858) 271-6962
(858) 271-5327
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ64795Z
BLUE SHIELD
CA
Enumeration date
12/01/2006
Last updated
11/30/2010
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