Healthcare Provider Details

I. General information

NPI: 1770492712
Provider Name (Legal Business Name): INTEGRATED BEHAVIORAL HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 LANGE AVE
SAN DIEGO CA
92122-3109
US

IV. Provider business mailing address

8885 RIO SAN DIEGO DR STE 133
SAN DIEGO CA
92108-1625
US

V. Phone/Fax

Practice location:
  • Phone: 619-848-5772
  • Fax:
Mailing address:
  • Phone: 619-848-5772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN PELOQUIN
Title or Position: CEO
Credential:
Phone: 619-818-5891