MEDICARE: SAN DIEGO COUNTY MENTAL HEALTH

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	251B00000X	Case Management Agency	MFT014311	CA

General Provider Information

NPI Number	:	1568599397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO COUNTY MENTAL HEALTH

Provider Business Mailing Address
First Line	:	1250 MORENA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3815
Country	:	US
Telephone Number	:	619-692-8708
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 MORENA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3815
Country	:	US
Telephone Number	:	619-692-8708
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH SERVICES DIRECTOR
Name	:	MR. ALFREDO AGUIRRE
Credential	:	L.C.S.W.
Telephone Number	:	619-692-8708

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	06/17/2008

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