Healthcare Provider Details

I. General information

NPI: 1023103595
Provider Name (Legal Business Name): COUNTY OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 CAROLINA LANE
SAN DIEGO CA
92102
US

IV. Provider business mailing address

6160 MISSION GORGE ROAD
SAN DIEGO CA
92120
US

V. Phone/Fax

Practice location:
  • Phone: 619-262-7342
  • Fax: 619-262-8918
Mailing address:
  • Phone: 619-528-4000
  • Fax: 619-528-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberCCS00041F
License Number StateCA

VIII. Authorized Official

Name: MS. ROBYN BURNS
Title or Position: CHIEF
Credential:
Phone: 619-528-4082