Healthcare Provider Details

I. General information

NPI: 1790980365
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 EDGEMOOR DR
SANTEE CA
92071-3037
US

IV. Provider business mailing address

3227 45TH ST
SAN DIEGO CA
92105-4305
US

V. Phone/Fax

Practice location:
  • Phone: 619-956-2943
  • Fax:
Mailing address:
  • Phone: 619-277-0745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number591207
License Number StateCA

VIII. Authorized Official

Name: MRS. SOYOUNG PHAYMANY
Title or Position: RN
Credential:
Phone: 619-956-2943