Healthcare Provider Details

I. General information

NPI: 1467657064
Provider Name (Legal Business Name): COUNTY OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9065 EDEGMOOR DRIVE
SANTEE CA
92071
US

IV. Provider business mailing address

12025 CALLE DE LEON APT 13
EL CAJON CA
92019-4900
US

V. Phone/Fax

Practice location:
  • Phone: 619-956-2955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number376421
License Number StateCA

VIII. Authorized Official

Name: MS. DELORES JOAN LEONARD
Title or Position: RN - STAFF NURSE 2
Credential:
Phone: 619-670-1523