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General NPI Number Information
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NPI Number | 1366255119
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Entity Type | Organization
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Legal Business Name | COUNTY OF SAN DIEGO SHERIFF
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1173 FRONT ST
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City | SAN DIEGO
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State | CA
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Zip | 92101-3904
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Country | US
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Telephone | 858-974-5971
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Fax |
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Provider Business Mailing Address
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Address Line | 5530 OVERLAND AVE STE 370
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City | SAN DIEGO
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State | CA
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Zip | 92123-1261
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Country | US
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Telephone | 858-974-5971
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Fax |
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Authorized Official
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Title or Position | MEDICAL SERVICES ADMINISTRATOR
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Name | CHRISTOPHER A MIEDICO
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Credential |
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Telephone | 858-974-5824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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