Healthcare Provider Details

I. General information

NPI: 1083557748
Provider Name (Legal Business Name): MANZANITA HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E CHASE AVE STE 109
EL CAJON CA
92020-6305
US

IV. Provider business mailing address

PO BOX 1302
BOULEVARD CA
91905-0402
US

V. Phone/Fax

Practice location:
  • Phone: 435-619-2393
  • Fax:
Mailing address:
  • Phone: 435-619-2393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DALLON ECHOHAWK
Title or Position: DEPUTY HEALTH DIRECTOR
Credential:
Phone: 435-619-2393