Healthcare Provider Details

I. General information

NPI: 1841316650
Provider Name (Legal Business Name): COUNTY OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 FALCONER RD
ESCONDIDO CA
92027-5331
US

IV. Provider business mailing address

420 FALCONER RD
ESCONDIDO CA
92027-5331
US

V. Phone/Fax

Practice location:
  • Phone: 760-432-2296
  • Fax: 760-432-9419
Mailing address:
  • Phone: 760-432-2296
  • Fax: 760-432-9419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT 4354
License Number StateCA

VIII. Authorized Official

Name: MRS. LISA SPEIER
Title or Position: OCCUPATIONAL THERAPIST
Credential:
Phone: 760-432-2296