Healthcare Provider Details

I. General information

NPI: 1255705703
Provider Name (Legal Business Name): SAN DIEGO CARE PLACEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3691 VIA MERCADO SUITE 16
LA MESA CA
91941-8325
US

IV. Provider business mailing address

3691 VIA MERCADO SUITE 16
LA MESA CA
91941-8325
US

V. Phone/Fax

Practice location:
  • Phone: 619-660-8814
  • Fax: 619-660-8815
Mailing address:
  • Phone: 619-660-8814
  • Fax: 619-660-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. DWAYNE JENSON
Title or Position: PRESIDENT & CEO
Credential:
Phone: 619-660-8814