Healthcare Provider Details

I. General information

NPI: 1760048086
Provider Name (Legal Business Name): INFO LINE OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 CALLE FORTUNADA STE 101
SAN DIEGO CA
92123-4802
US

IV. Provider business mailing address

PO BOX 420039
SAN DIEGO CA
92142-0039
US

V. Phone/Fax

Practice location:
  • Phone: 858-300-1211
  • Fax:
Mailing address:
  • Phone: 858-380-5263
  • Fax:

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 Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: PAUL REDFERN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 858-380-5263