| San Diego Internal Medicine Associates | |
|
8765 Aero Drive Suite 130 San Diego CA 92123-1767 | |
| (858) 541-0181 | |
| (858) 637-9035 |
| Full Name | San Diego Internal Medicine Associates |
|---|---|
| Speciality | Internal Medicine |
| Location | 8765 Aero Drive, San Diego, California |
| Authorized Official Name and Position | Kenneth J Roth (GENERAL PARTNER) |
| Authorized Official Contact | 8585410181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Diego Internal Medicine Associates 8765 Aero Drive Suite 130 San Diego CA 92123-1767 Ph: (858) 541-0181 | San Diego Internal Medicine Associates 8765 Aero Drive Suite 130 San Diego CA 92123-1767 Ph: (858) 541-0181 |
| NPI Number | 1578657383 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 07/23/2024 |
| Medicare PECOS PAC ID | 1658368162 |
|---|---|
| Medicare Enrollment ID | O20040427001338 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578657383 | NPI | - | NPPES |
| W12070 | Other | CA | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RA0000X | Internal Medicine - Adolescent Medicine | (* (Not Available)) | Primary |
| Provider Name | D Scott Upton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417994898 PECOS PAC ID: 9436127586 Enrollment ID: I20040917000294 |
| Provider Name | Kenneth J Roth |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750475562 PECOS PAC ID: 9032003090 Enrollment ID: I20080331000258 |
| Provider Name | Karim Mansour |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942238878 PECOS PAC ID: 3375620040 Enrollment ID: I20080404000384 |
| Provider Name | Rolf Ehlers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205939832 PECOS PAC ID: 5092892505 Enrollment ID: I20080408000857 |
| Provider Name | Laura Marie Williams Wayne |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174729255 PECOS PAC ID: 4183710726 Enrollment ID: I20120802000186 |
| Provider Name | Jennifer Alberto Obana |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114368628 PECOS PAC ID: 5092933317 Enrollment ID: I20170816000806 |
| Provider Name | Grant Meyer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174900823 PECOS PAC ID: 4880968957 Enrollment ID: I20171221001611 |
| Provider Name | Tiffany Chan Sena |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710539523 PECOS PAC ID: 8921405523 Enrollment ID: I20210924000266 |
| Provider Name | Kate Pinkerton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134329287 PECOS PAC ID: 3577653914 Enrollment ID: I20230710002011 |
| Provider Name | Jeffrey Abrahm Cohen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1184184251 PECOS PAC ID: 1951632389 Enrollment ID: I20230720002834 |
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