Healthcare Provider Details

I. General information

NPI: 1811237928
Provider Name (Legal Business Name): THE LGBT COMMUNITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 CENTRE ST
SAN DIEGO CA
92103-3410
US

IV. Provider business mailing address

3909 CENTRE ST
SAN DIEGO CA
92103-3410
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-2077
  • Fax: 619-718-6447
Mailing address:
  • Phone: 619-692-2077
  • Fax: 619-718-6447

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: AUTUMN RASHAK
Title or Position: DATABASE MANAGER
Credential:
Phone: 619-692-2077