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General NPI Number Information
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NPI Number | 1013363035
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Entity Type | Organization
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Legal Business Name | UPAC TRC
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 1405 PARK BLVD BUILDING 100
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City | SAN DIEGO
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State | CA
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Zip | 92101-4722
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Country | US
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Telephone | 619-521-5720
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Fax |
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Provider Business Mailing Address
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Address Line | 3288 EL CAJON BLVD STE 13
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City | SAN DIEGO
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State | CA
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Zip | 92104-1430
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Country | US
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Telephone | 619-521-5720
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | COURTNEY BOATMAN
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Credential | LMFT
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Telephone | 619-521-5720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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