Organization
REGENTS OF THE UNIVERSITY OF CALIFORNIA
Active
Parent organization
UCSD MEDICAL CENTER
Other names
Koman Family Outpatient Pavilion
Organization subpart
Yes
Provider details
NPI number
Legal business name
UCSD MEDICAL CENTER
Authorized official
LORI DONALDSON (CFO)
(619) 543-6613
Entity
Organization
Contact information
Practice address
9400 CAMPUS POINT DR, LA JOLLA, CA 92093-1350
(800) 926-8273
Mailing address
FILE NO 57326, LOS ANGELES, CA 90074-0001
(858) 249-6748
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
03/15/2019
Last updated
03/15/2019
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