Organization
REGENTS OF THE UNIVERSITY OF CALIFORNIA
Active
Other names
UCSD Pediatric and Adolescent Associates
Organization subpart
No
Provider details
NPI number
Authorized official
BRETTEN DRAKE PICKERING M.D. (DIVISION CHIEF OF GENERAL ACADEMIC)
(858) 496-4827
Entity
Organization
Contact information
Practice address
7910 FROST STREET, STE 350, SAN DIEGO, CA 92123-2771
(858) 496-4800
(858) 496-4850
Mailing address
3860 CALLE FORTUNADA, STE 200, SAN DIEGO, CA 92123-4800
(858) 502-1135
(858) 636-4319
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0105540
—
CA
01
—
ZZZ69468Z
BLUE SHIELD
CA
Enumeration date
03/27/2007
Last updated
09/24/2008
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