MEDICARE: SURVIVORS OF TORTURE, INTERNATIONAL

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	PSY6363	CA
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1598936643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURVIVORS OF TORTURE, INTERNATIONAL

Provider Business Mailing Address
First Line	:	3990 OLD TOWN AVE STE 201C
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-2933
Country	:	US
Telephone Number	:	619-278-2400
Fax Number	:	619-294-9405

Provider Business Practice Location Address
First Line	:	3990 OLD TOWN AVE STE C201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-2933
Country	:	US
Telephone Number	:	619-278-2400
Fax Number	:	619-294-9429

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ETLEVA BEJKO
Credential	:
Telephone Number	:	619-278-2407

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	11/04/2024

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