DR. ITHAAR DERWEESH MD NPI 1003873720

Urology in La Jolla, CA

About ITHAAR DERWEESH

Ithaar Derweesh is a provider in La Jolla, CA with more than 23 years of experience. The NPI number assigned to this provider is 1003873720. The practitioner's primary taxonomy code is Urology (208800000X). The provider is registered as an individual and their NPI record was last updated 7 years ago. Ithaar Derweesh is registered with Medicare and accepts claims assignment.

NPI1003873720 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameDR. ITHAAR DERWEESH MD
Provider Location Address3855 HEALTH SCIENCES DRIVE MAIL CODE 0987 LA JOLLA, CA 92093 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address200 W ARBOR DRIVE MAIL CODE 8897 SAN DIEGO, CA 92103 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Medical School NameOTHER
Graduation Year1995
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date04-27-2006 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date11-01-2010 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

DR. ITHAAR DERWEESH MD
3855 HEALTH SCIENCES DRIVE
MAIL CODE 0987
LA JOLLA, CA
ZIP 92093
Phone: (858) 822-7874
Fax: (901) 448-6657
Get Directions

Mailing Address

DR. ITHAAR DERWEESH MD
200 W ARBOR DRIVE
MAIL CODE 8897
SAN DIEGO, CA
ZIP 92103
Phone: (858) 822-6187
Fax: (858) 822-6188

Primary Taxonomy

Taxonomy Code208800000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationUrology
TypeAllopathic & Osteopathic Physicians
License No.40071
License StateTN
Taxonomy DescriptionA urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
3332625MEDICARE ID-TYPE UNSPECIFIED (04)
3332625MEDICAID (05)TN
H62034MEDICARE UPIN (02)

Map Location


DR. ITHAAR DERWEESH MD address is 3855 HEALTH SCIENCES DRIVE MAIL CODE 0987 LA JOLLA, CA 92093

Other Providers at the same location


The following 7 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1073932877MR. JEFFREY FRANKLIN BURKEEN M.D.
Individual
Student in an Organized Health Care Education/Training Program3855 HEALTH SCIENCES DRIVE UCSD RADIATION MEDICINE AND APPLIED SCIENCES
LA JOLLA, CA 92093
(858) 822-0640
1215124664DR. CAROLYN MARIE MULRONEY MD
Individual
Specialist3855 HEALTH SCIENCES DRIVE #0960
LA JOLLA, CA 92093
(858) 822-6600
1295962025 PAMELA S JONES MD
Individual
Neurological Surgery3855 HEALTH SCIENCES DRIVE
LA JOLLA, CA 92093
(858) 822-6176
1346323904DR. TONY R REID M.D
Individual
3855 HEALTH SCIENCES DRIVE MAIL CODE 0987
LA JOLLA, CA 92093
(858) 822-6440
1750391512MS. CYNTHIA MARGARET CIASCHI NP
Individual
Nurse Practitioner3855 HEALTH SCIENCES DRIVE MC 0957
LA JOLLA, CA 92093
(858) 657-7000
1871537191DR. HAYDEE OJEDA-FOURNIER MD
Individual
Radiology (Diagnostic Radiology)3855 HEALTH SCIENCES DRIVE MC0846
LA JOLLA, CA 92093
(858) 822-6121
1922056373DR. FREDERICK EDWARD MILLARD M.D.
Individual
Internal Medicine (Hematology & Oncology)3855 HEALTH SCIENCES DRIVE MOORES UCSD CANCER CENTER , MC 0987
LA JOLLA, CA 92093
(858) 822-6185