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General NPI Number Information
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NPI Number | 1033080205
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Entity Type | Organization
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Legal Business Name | INCLUDED
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 4761 CASS ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-2604
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Country | US
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Telephone | 203-543-2994
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Fax |
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Provider Business Mailing Address
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Address Line | 4761 CASS ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-2604
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Country | US
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Telephone | 203-543-2994
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Fax |
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Authorized Official
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Title or Position | CLINICAL COORDINATOR
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Name | MS. AISLINN CLARE MCKEOWN
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Credential | MS, OTR/L
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Telephone | 203-543-2994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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