Healthcare Provider Details

I. General information

NPI: 1578783635
Provider Name (Legal Business Name): SAN DIEGO COUNTY CASE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 MORENA BLVD
SAN DIEGO CA
92110-3815
US

IV. Provider business mailing address

6042 FLIPPER DR
SAN DIEGO CA
92114-5510
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-8715
  • Fax: 619-542-4969
Mailing address:
  • Phone: 619-847-1001
  • Fax: 619-542-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL LOUISE GORMAN
Title or Position: MENTAL HEALTH SPECIALIST
Credential: B. S.
Phone: 619-692-8718