Healthcare Provider Details

I. General information

NPI: 1528055787
Provider Name (Legal Business Name): POINT LOMA CONVALESCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 DUKE ST
SAN DIEGO CA
92110-5401
US

IV. Provider business mailing address

3202 DUKE ST
SAN DIEGO CA
92110-5401
US

V. Phone/Fax

Practice location:
  • Phone: 619-224-4141
  • Fax: 619-224-1328
Mailing address:
  • Phone: 619-224-4141
  • Fax: 619-224-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: KITTY TEEL
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 619-224-4141