Organization
SCRIPPS CLINIC MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT B. SARNOFF M.D. (PRESIDENT)
(858) 554-8862
Entity
Organization
Contact information
Practice address
15004 INNOVATION DR, SAN DIEGO, CA 92128-3491
(858) 487-1800
Mailing address
FILE # 54433, LOS ANGELES, CA 90074-0001
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C40904
RAILROAD MEDICARE
—
01
—
ZZZ81776Z
BLUE SHIELD OF CALIFORNIA
CA
05
—
ZZZ81776Z
—
CA
Enumeration date
12/08/2005
Last updated
06/24/2009
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