Healthcare Provider Details

I. General information

NPI: 1598217135
Provider Name (Legal Business Name): RECOVERY PARTNERS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11720 EL CAMINO REAL SUITE 200
SAN DIEGO CA
92130-2224
US

IV. Provider business mailing address

11720 EL CAMINO REAL SUITE 200
SAN DIEGO CA
92130-2224
US

V. Phone/Fax

Practice location:
  • Phone: 858-766-9980
  • Fax:
Mailing address:
  • Phone: 858-766-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MARVIN D SEPPALA
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 858-766-9980