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General NPI Number Information
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NPI Number | 1124910849
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Entity Type | Organization
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Legal Business Name | MATERNAL HAVEN LLC
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 375 CAMINO DE LA REINA APT 247
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City | SAN DIEGO
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State | CA
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Zip | 92108-3095
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Country | US
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Telephone | 619-289-9388
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Fax |
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Provider Business Mailing Address
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Address Line | 4660 LA JOLLA VILLAGE DR STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92122-4604
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Country | US
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Telephone | 619-289-9388
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ANDREA PICHATARO
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Credential | CD
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Telephone | 619-289-9388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 174H00000X
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Taxonomy Name | Health Educator
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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