Healthcare Provider Details

I. General information

NPI: 1215855598
Provider Name (Legal Business Name): CORRECTIONAL HEALTHCARE PARTNERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 FRONT ST
SAN DIEGO CA
92101-3904
US

IV. Provider business mailing address

4365 EXECUTIVE DR STE 540
SAN DIEGO CA
92121-2128
US

V. Phone/Fax

Practice location:
  • Phone: 619-610-1647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NICK MORENO
Title or Position: COO
Credential:
Phone: 858-354-0945