Healthcare Provider Details

I. General information

NPI: 1194972174
Provider Name (Legal Business Name): SAN DIEGO YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 CORDELL CT SUITE 101
EL CAJON CA
92020-0914
US

IV. Provider business mailing address

3255 WING ST
SAN DIEGO CA
92110-4638
US

V. Phone/Fax

Practice location:
  • Phone: 619-448-9700
  • Fax: 619-448-9711
Mailing address:
  • Phone: 619-221-8601
  • Fax: 619-221-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number37GC
License Number StateCA

VIII. Authorized Official

Name: MR. WALTER PHILIPS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 619-221-8601