=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396898474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY O SAN DIEGO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2901 MEADOW LARK DR
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-2711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-577-0231
-----------------------------------------------------
Fax | 858-694-4492
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2901 MEADOW LARK DR
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-2711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-694-4680
-----------------------------------------------------
Fax | 858-694-4492
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, BEHAVIOR HEALTH SERVICES
-----------------------------------------------------
Name | MR. LUKE BERGMANN
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 619-563-2700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------