Healthcare Provider Details

I. General information

NPI: 1659464410
Provider Name (Legal Business Name): COUNTY OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E. NAPLES ST. RM 28
CHULA VISTA CA
91911
US

IV. Provider business mailing address

6160 MISSION GORGE RD.
SAN DIEGO CA
92120
US

V. Phone/Fax

Practice location:
  • Phone: 619-421-6083
  • Fax: 619-482-8284
Mailing address:
  • Phone: 619-528-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberCCS00039F
License Number StateCA

VIII. Authorized Official

Name: ROBYN BURNS
Title or Position: CHIEF
Credential:
Phone: 619-528-4082