Healthcare Provider Details

I. General information

NPI: 1609792530
Provider Name (Legal Business Name): VISIONARY MENTAL & BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CARPINTERIA ST
CHULA VISTA CA
91913-2520
US

IV. Provider business mailing address

1350 CARPINTERIA ST
CHULA VISTA CA
91913-2520
US

V. Phone/Fax

Practice location:
  • Phone: 540-664-3885
  • Fax:
Mailing address:
  • Phone: 540-664-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: LINDA UPDEGRAFF
Title or Position: OWNER
Credential:
Phone: 540-664-3885