Provider Demographics
NPI:1194498303
Name:BRIDGE PHYSICIAN NETWORK SAN DIEGO PC
Entity type:Organization
Organization Name:BRIDGE PHYSICIAN NETWORK SAN DIEGO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-251-4242
Mailing Address - Street 1:3636 NOBEL DR STE 450
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1062
Mailing Address - Country:US
Mailing Address - Phone:858-251-4242
Mailing Address - Fax:
Practice Address - Street 1:3636 NOBEL DR STE 450
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1062
Practice Address - Country:US
Practice Address - Phone:858-251-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty