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General NPI Number Information
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NPI Number | 1336472869
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Entity Type | Organization
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Legal Business Name | NMCSD
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 34800 BOB WILSON DR NMCSD
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City | SAN DIEGO
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State | CA
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Zip | 92134-1098
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Country | US
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Telephone | 858-753-1735
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Fax |
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Provider Business Mailing Address
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Address Line | 2435 ADAMS AVE #5
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City | SAN DIEGO
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State | CA
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Zip | 92116-1343
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ALEKSANDRA MARINOVIC
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Credential | PSY.D.
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Telephone | 858-349-4496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 22507
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 22507
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License Number State | CA
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