Healthcare Provider Details

I. General information

NPI: 1992820195
Provider Name (Legal Business Name): SAN DIEGO UNIFIED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 MOUNT ACKERLY DR
SAN DIEGO CA
92111-4016
US

IV. Provider business mailing address

5650 MT ACKERLY DRIVE
SAN DIEGO CA
92111
US

V. Phone/Fax

Practice location:
  • Phone: 858-496-1655
  • Fax: 858-496-1660
Mailing address:
  • Phone: 858-496-1655
  • Fax: 858-496-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: YUKA SAKAMOTO
Title or Position: PROGRAM MANAGER
Credential:
Phone: 858-573-2227