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General NPI Number Information
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NPI Number | 1053254714
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Entity Type | Organization
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Legal Business Name | MANZANITA HEALTH DEPARTMENT
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Dates
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Enumeration Date | 04/09/2026
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 222 3RD AVE
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City | CHULA VISTA
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State | CA
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Zip | 91910-2711
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Country | US
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Telephone | 435-619-2393
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1302
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City | BOULEVARD
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State | CA
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Zip | 91905-0402
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Country | US
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Telephone | 435-619-2393
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Fax |
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Authorized Official
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Title or Position | DEPUTY HEALTH DIRECTOR
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Name | DALLON ECHOHAWK
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Credential |
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Telephone | 435-619-2393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number |
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License Number State |
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