Provider Demographics
NPI:1891131314
Name:UCSD OCCUPATIONAL MEDICINE
Entity type:Organization
Organization Name:UCSD OCCUPATIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT II
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-543-7054
Mailing Address - Street 1:PO BOX 34457
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-4457
Mailing Address - Country:US
Mailing Address - Phone:619-543-7060
Mailing Address - Fax:619-543-7065
Practice Address - Street 1:8899 UNIVERSITY CENTER LN STE 160
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1035
Practice Address - Country:US
Practice Address - Phone:858-657-1600
Practice Address - Fax:858-657-1606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UC SAN DIEGO HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000101261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine