Healthcare Provider Details

I. General information

NPI: 1336508621
Provider Name (Legal Business Name): DISCOVERY PRACTICE MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 CAMINO REAL STE 360
SAN DIEGO CA
92130
US

IV. Provider business mailing address

4281 KATELLA AVE SUITE 111
LOS ALAMITOS CA
90720-3510
US

V. Phone/Fax

Practice location:
  • Phone: 866-382-1306
  • Fax: 714-388-3894
Mailing address:
  • Phone: 714-828-1800
  • Fax: 714-828-1868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KERRYLYNN BACA
Title or Position: INSURANCE CONTRACTING
Credential:
Phone: 714-828-1800