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Organization
SAN DIEGO HOSPITAL BASED PHYSICIANS MEDICAL ASSOCIATION
Active
Organization
SAN DIEGO HOSPITAL BASED PHYSICIANS MEDICAL ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SULLIVAN M.D. (PRESIDENT)
(619) 294-8111
Entity
Organization
Contact information
Practice address
4077 FIFTH AVE, SAN DIEGO, CA 92103-2105
(619) 294-8111
Mailing address
PO BOX 87729, SAN DIEGO, CA 92138-7729
(619) 285-5996
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0076320
—
CA
Enumeration date
05/10/2006
Last updated
08/22/2020
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