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NPI Code Detail

MEDICARE: SYCUAN TRIBAL GOVERNMENT

MEDICARE: SYCUAN TRIBAL GOVERNMENT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332800000XIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
2333600000XPharmacy
33336C0003XCommunity/Retail PharmacyPHE39873CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12094469OTHERPK

General Provider Information

NPI Number : 1164553053
Entity Type Code : Organization
Provider Name (Legal Business Name) : SYCUAN TRIBAL GOVERNMENT
Provider Business Mailing Address
First Line : 4921 DEHESA RD
Second Line :
City : EL CAJON
State : CA
Zip : 92019-2929
Country : US
Telephone Number : 619-445-0707
Fax Number : 619-445-0901
Provider Business Practice Location Address
First Line : 4921 DEHESA RD
Second Line :
City : EL CAJON
State : CA
Zip : 92019-2929
Country : US
Telephone Number : 619-445-0707
Fax Number : 619-445-0901
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MAURICE SMITH
Credential :
Telephone Number : 619-445-0707
Provider Enumeration Date : 03/09/2007
Last Update Date : 02/13/2026

Similar Medicare Providers

1043218191 — SYCUAN TRIBAL GOVERNMENT
Practice Location Address:
4921 DEHESA RD
EL CAJON, CA
92019-2929
Practice Phone: 619-445-0707
Practice Fax: 619-445-0901
1548269194 — DR. RANDALL T TANAKA DDS
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1023085560 — WENDY M ALVA CPNP, PMHNP-BC
Practice Location Address:
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EL CAJON, CA
92019-2929
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Practice Fax: 619-445-0901
1730132457 — ARJUN N REDDY MD
Practice Location Address:
4921 DEHESA RD
EL CAJON, CA
92019-2929
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Practice Fax: 619-445-0901
1528114980 — YEMISRACH A. BEYENE M.D.
Practice Location Address:
4921 DEHESA RD
EL CAJON, CA
92019-2929
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Practice Fax: 619-445-0901
1427197078 — SYCUAN TRIBAL GOVERNMENT
Practice Location Address:
4921 DEHESA RD
EL CAJON, CA
92019-2929
Practice Phone: 619-445-0707
Practice Fax: 619-445-0901

Directions to “SYCUAN TRIBAL GOVERNMENT ” Practice Location

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