Healthcare Provider Details

I. General information

NPI: 1730227653
Provider Name (Legal Business Name): TELECARE SAN DIEGO REACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 26TH ST FL 6
SAN DIEGO CA
92102-3026
US

IV. Provider business mailing address

446 26TH ST FL 6
SAN DIEGO CA
92102-3026
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-2181
  • Fax: 619-398-2171
Mailing address:
  • Phone: 619-398-2181
  • Fax: 619-398-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. GABRIEL BANUELOS
Title or Position: PERSONAL SERVICE COORDINATOR I
Credential:
Phone: 619-398-2181