Healthcare Provider Details

I. General information

NPI: 1437877123
Provider Name (Legal Business Name): ALBA CENTER MARRIAGE AND FAMILY THERPAY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 4TH AVE STE 3
SAN DIEGO CA
92103-6223
US

IV. Provider business mailing address

2729 4TH AVE STE 3
SAN DIEGO CA
92103-6223
US

V. Phone/Fax

Practice location:
  • Phone: 619-370-7545
  • Fax: 619-924-0298
Mailing address:
  • Phone: 619-370-7545
  • Fax: 619-924-0298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name: ESTELA CECILIA BOBADILLA
Title or Position: DIRECTOR
Credential: LMFT
Phone: 619-370-7545