Healthcare Provider Details

I. General information

NPI: 1689906851
Provider Name (Legal Business Name): SAN DIEGO DEAF MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BROADWAY FL 2
SAN DIEGO CA
92101-5391
US

IV. Provider business mailing address

707 BROADWAY FL 2
SAN DIEGO CA
92101-5391
US

V. Phone/Fax

Practice location:
  • Phone: 858-410-1067
  • Fax:
Mailing address:
  • Phone: 858-410-1067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateCA

VIII. Authorized Official

Name: ALLISON SEPULVEDA
Title or Position: EXECUTIVE DIRECTOR
Credential: M.A.
Phone: 858-410-1067