MEDICARE: COUNTY O 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
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396898474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY O SAN DIEGO

Provider Business Mailing Address
First Line	:	2901 MEADOW LARK DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2711
Country	:	US
Telephone Number	:	858-694-4680
Fax Number	:	858-694-4492

Provider Business Practice Location Address
First Line	:	2901 MEADOW LARK DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2711
Country	:	US
Telephone Number	:	619-577-0231
Fax Number	:	858-694-4492

Authorized Official
Title or Position	:	DIRECTOR, BEHAVIOR HEALTH SERVICES
Name	:	MR. LUKE BERGMANN
Credential	:	PHD
Telephone Number	:	619-563-2700

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	10/28/2025

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Directions to “COUNTY O SAN DIEGO ” Practice Location

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