Healthcare Provider Details

I. General information

NPI: 1386469237
Provider Name (Legal Business Name): TRANSCEND BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2024
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 PARK BLVD STE 204
SAN DIEGO CA
92116-4039
US

IV. Provider business mailing address

4452 PARK BLVD STE 204
SAN DIEGO CA
92116-4039
US

V. Phone/Fax

Practice location:
  • Phone: 619-823-1382
  • Fax:
Mailing address:
  • Phone: 619-823-1382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY KULETO
Title or Position: CEO
Credential: MD
Phone: 858-692-8043