Healthcare Provider Details

I. General information

NPI: 1396898474
Provider Name (Legal Business Name): COUNTY O SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 MEADOW LARK DR
SAN DIEGO CA
92123-2711
US

IV. Provider business mailing address

2901 MEADOW LARK DR
SAN DIEGO CA
92123-2711
US

V. Phone/Fax

Practice location:
  • Phone: 619-577-0231
  • Fax: 858-694-4492
Mailing address:
  • Phone: 858-694-4680
  • Fax: 858-694-4492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LUKE BERGMANN
Title or Position: DIRECTOR, BEHAVIOR HEALTH SERVICES
Credential: PHD
Phone: 619-563-2700