Healthcare Provider Details

I. General information

NPI: 1053823385
Provider Name (Legal Business Name): KAREN DIEGA FADDIS SUDCC II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KAREN DIEGA

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 JEFFERSON ST
SAN DIEGO CA
92110-4421
US

IV. Provider business mailing address

1400 N JOHNSON AVE STE 101
EL CAJON CA
92020
US

V. Phone/Fax

Practice location:
  • Phone: 619-683-3100
  • Fax:
Mailing address:
  • Phone: 619-440-4801
  • Fax: 619-442-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11452
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: