Healthcare Provider Details

I. General information

NPI: 1275669582
Provider Name (Legal Business Name): SPECIAL EDUCATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 KEMPER ST SUITE 104
SAN DIEGO CA
92110-4903
US

IV. Provider business mailing address

3320 KEMPER ST SUITE 104
SAN DIEGO CA
92110-4903
US

V. Phone/Fax

Practice location:
  • Phone: 619-758-6205
  • Fax: 619-758-6209
Mailing address:
  • Phone: 619-758-6205
  • Fax: 619-758-6209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ALFREDO AGUIRRE
Title or Position: DEPUTY DIRECTOR, MENTAL HEALTH SRV
Credential: LCSW
Phone: 619-563-2711