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General NPI Number Information
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NPI Number | 1164553053
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Entity Type | Organization
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Legal Business Name | SYCUAN TRIBAL GOVERNMENT
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 4921 DEHESA RD
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City | EL CAJON
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State | CA
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Zip | 92019-2929
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Country | US
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Telephone | 619-445-0707
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Fax | 619-445-0901
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Provider Business Mailing Address
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Address Line | 4921 DEHESA RD
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City | EL CAJON
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State | CA
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Zip | 92019-2929
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Country | US
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Telephone | 619-445-0707
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Fax | 619-445-0901
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MAURICE SMITH
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Credential |
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Telephone | 619-445-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHE39873
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License Number State | CA
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