Provider Demographics
NPI:1316462377
Name:UCSD SURGICAL CENTER OF SAN DIEGO, LLC
Entity type:Organization
Organization Name:UCSD SURGICAL CENTER OF SAN DIEGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRELLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-750-4800
Mailing Address - Street 1:4910 DIRECTORS PL STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3814
Mailing Address - Country:US
Mailing Address - Phone:858-750-4800
Mailing Address - Fax:
Practice Address - Street 1:4910 DIRECTORS PL STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3814
Practice Address - Country:US
Practice Address - Phone:858-750-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical