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NPI Code Detail

MEDICARE: VIETNAM VETERANS OF SAN DIEGO

MEDICARE: VIETNAM VETERANS OF SAN DIEGO
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
1324500000XSubstance Abuse Rehabilitation Facility370010BNCA

General Provider Information

NPI Number : 1396873451
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIETNAM VETERANS OF SAN DIEGO
Provider Business Mailing Address
First Line : 4141 PACIFIC HWY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-2030
Country : US
Telephone Number : 619-497-0142
Fax Number : 619-497-0263
Provider Business Practice Location Address
First Line : 4141 PACIFIC HWY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-2030
Country : US
Telephone Number : 619-497-0142
Fax Number : 619-497-0263
Authorized Official
Title or Position : PRESIDENT & C.E.O.
Name : MR. PHIL LANDIS
Credential :
Telephone Number : 619-497-0142
Provider Enumeration Date : 03/01/2007
Last Update Date : 06/10/2016

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Directions to “VIETNAM VETERANS OF SAN DIEGO ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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