| Scripps Ranch Medical Clinic | |
|
9999 Mira Mesa Blvd Ste 104 San Diego CA 92131-1006 | |
| (858) 271-6962 | |
| (858) 271-5327 |
| Full Name | Scripps Ranch Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 9999 Mira Mesa Blvd Ste 104, San Diego, California |
| Authorized Official Name and Position | Jack Wasserman (GEN PTR/MEDICAL DIRECTOR) |
| Authorized Official Contact | 8582716962 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Scripps Ranch Medical Clinic 9999 Mira Mesa Blvd Ste 104 San Diego CA 92131-1006 Ph: (858) 271-6962 | Scripps Ranch Medical Clinic 9999 Mira Mesa Blvd Ste 104 San Diego CA 92131-1006 Ph: (858) 271-6962 |
| NPI Number | 1285702654 |
|---|---|
| Provider Enumeration Date | 12/01/2006 |
| Last Update Date | 11/30/2010 |
| Medicare PECOS PAC ID | 5193770352 |
|---|---|
| Medicare Enrollment ID | O20050321000699 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285702654 | NPI | - | NPPES |
| ZZZ64795Z | Other | CA | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Adrienne Ertl |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427126895 PECOS PAC ID: 3072568260 Enrollment ID: I20050321000951 |
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