Healthcare Provider Details

I. General information

NPI: 1689968737
Provider Name (Legal Business Name): SAN DIEGO COUNTY PSYCHIATRIC HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3853 ROSECRANS ST
SAN DIEGO CA
92110-3115
US

IV. Provider business mailing address

3853 ROSECRANS ST
SAN DIEGO CA
92110-3115
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-8222
  • Fax:
Mailing address:
  • Phone: 619-692-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number23671
License Number StateCA

VIII. Authorized Official

Name: SHARON CASTRO
Title or Position: LPT
Credential:
Phone: 619-692-8222