Provider Demographics
NPI:1043665425
Name:SCRIPPS HEALTH
Entity type:Organization
Organization Name:SCRIPPS HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-678-6828
Mailing Address - Street 1:10790 RANCHO BERNARDO RD.
Mailing Address - Street 2:2ND FL.
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-678-7111
Mailing Address - Fax:858-678-6663
Practice Address - Street 1:4060 4TH AVE.
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2116
Practice Address - Country:US
Practice Address - Phone:858-678-7111
Practice Address - Fax:858-678-6663
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCRIPPS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-04
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY54317333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159844OtherPK