1891017729 NPI number — UC SAN DIEGO DEPARTMENT OF ANESTHESIOLOGY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891017729 NPI number — UC SAN DIEGO DEPARTMENT OF ANESTHESIOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UC SAN DIEGO DEPARTMENT OF ANESTHESIOLOGY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891017729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 KETTNER BLVD
Provider Second Line Business Mailing Address:
UNIT 202
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92101-5908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-324-1399
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W ARBOR DRIVE, #0801
Provider Second Line Business Practice Location Address:
UCSD DEPT OF ANESTHESIOLOGY
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-324-1399
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MANECKE
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
619-471-0670

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: A117918 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)