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NPI Code Detail

MEDICARE: SAN DIEGO COUNTY

MEDICARE: SAN DIEGO COUNTY
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
1106H00000XMarriage & Family Therapist48542CA

General Provider Information

NPI Number : 1861523003
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN DIEGO COUNTY
Provider Business Mailing Address
First Line : 8690 AERO DR
Second Line : SUITE 115-41
City : SAN DIEGO
State : CA
Zip : 92123-1886
Country : US
Telephone Number : 619-987-2797
Fax Number :
Provider Business Practice Location Address
First Line : 3177 OCEAN VIEW BLVD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92113-1432
Country : US
Telephone Number : 619-987-2797
Fax Number :
Authorized Official
Title or Position : CLINICAL SUPERVISOR
Name : ANNE FITZGERALD
Credential : LCSW
Telephone Number : 619-595-4418
Provider Enumeration Date : 03/08/2007
Last Update Date : 08/21/2012

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Directions to “SAN DIEGO COUNTY ” Practice Location

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