Healthcare Provider Details

I. General information

NPI: 1568611135
Provider Name (Legal Business Name): COUNTY OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3977 OHIO ST
SAN DIEGO CA
92104-3014
US

IV. Provider business mailing address

3977 OHIO ST
SAN DIEGO CA
92104-3014
US

V. Phone/Fax

Practice location:
  • Phone: 619-574-5552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ANNA M GUZMAN
Title or Position: SUPERVISIOR
Credential:
Phone: 619-574-5552