Healthcare Provider Details

I. General information

NPI: 1700989829
Provider Name (Legal Business Name): SAN DIEGO HEALTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 METROPOLITAN DR
SAN DIEGO CA
92108-4402
US

IV. Provider business mailing address

6183 PASEO DEL NORTE STE 200
CARLSBAD CA
92011-1151
US

V. Phone/Fax

Practice location:
  • Phone: 619-718-9890
  • Fax: 619-718-9897
Mailing address:
  • Phone: 855-259-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number37-15
License Number StateCA

VIII. Authorized Official

Name: BRIAN PHILLIP FARLEY
Title or Position: VP & SECRETARY
Credential:
Phone: 615-861-6000