Healthcare Provider Details

I. General information

NPI: 1093128324
Provider Name (Legal Business Name): COUNTY OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MEDICAL CENTER CT
CHULA VISTA CA
91911-6618
US

IV. Provider business mailing address

730 MEDICAL CENTER CT
CHULA VISTA CA
91911-6618
US

V. Phone/Fax

Practice location:
  • Phone: 619-421-6900
  • Fax: 619-421-7186
Mailing address:
  • Phone: 619-421-6900
  • Fax: 619-421-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ALFREDO AGUIRRE
Title or Position: DEPUTY DIRECTOR, MENTAL HEALTH SRVS
Credential: LCSW
Phone: 619-563-2711