Healthcare Provider Details

I. General information

NPI: 1669442059
Provider Name (Legal Business Name): PALOMAR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15615 POMERADO ROAD
POWAY CA
92064
US

IV. Provider business mailing address

2125 CITRACADO PKWY STE 300
ESCONDIDO CA
92029-4159
US

V. Phone/Fax

Practice location:
  • Phone: 858-613-4000
  • Fax: 760-480-7966
Mailing address:
  • Phone:
  • Fax: 760-480-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number080000127
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: DIANE HANSEN
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 760-740-6385