Healthcare Provider Details

I. General information

NPI: 1053259812
Provider Name (Legal Business Name): GREATER SAN DIEGO ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14545 LYONS VALLEY RD
JAMUL CA
91935-3324
US

IV. Provider business mailing address

14545 LYONS VALLEY RD
JAMUL CA
91935-3324
US

V. Phone/Fax

Practice location:
  • Phone: 619-669-3050
  • Fax:
Mailing address:
  • Phone: 619-669-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE ANN
Title or Position: DIRECTOR
Credential:
Phone: 619-669-3064