Healthcare Provider Details

I. General information

NPI: 1386548170
Provider Name (Legal Business Name): SAN DIEGO ACADEMY OF EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 MARCY AVE
SAN DIEGO CA
92113-2340
US

IV. Provider business mailing address

2716 MARCY AVE
SAN DIEGO CA
92113-2340
US

V. Phone/Fax

Practice location:
  • Phone: 619-232-2825
  • Fax:
Mailing address:
  • Phone: 619-232-2825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAURA MAY
Title or Position: CAO
Credential:
Phone: 619-255-1511