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General NPI Number Information
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NPI Number | 1225836133
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Entity Type | Organization
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Legal Business Name | FUNDAMENTAL HEALTH
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 501 W BROADWAY STE 1540
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City | SAN DIEGO
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State | CA
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Zip | 92101-3770
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Country | US
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Telephone | 619-728-5065
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Fax |
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Provider Business Mailing Address
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Address Line | 501 W BROADWAY STE 1540
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City | SAN DIEGO
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State | CA
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Zip | 92101-3770
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Country | US
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Telephone | 619-292-8072
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Fax |
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | LEIGH-ANN CARDELFE
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Credential |
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Telephone | 619-292-8072
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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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