Healthcare Provider Details

I. General information

NPI: 1497780480
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF THE PACIFIC SOUTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 1ST AVE STE 100
SAN DIEGO CA
92101-9001
US

IV. Provider business mailing address

1075 CAMINO DEL RIO S
SAN DIEGO CA
92108-3538
US

V. Phone/Fax

Practice location:
  • Phone: 619-881-4516
  • Fax:
Mailing address:
  • Phone: 619-881-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number0507268
License Number StateCA

VIII. Authorized Official

Name: THERESA GONZALES
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 619-881-4516