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General NPI Number Information
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NPI Number | 1497943336
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Entity Type | Organization
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Legal Business Name | SOUTH BAY COMMUNITY SERVICES
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 430 F ST
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City | CHULA VISTA
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State | CA
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Zip | 91910-3711
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Country | US
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Telephone | 619-420-3620
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Fax | 619-420-8722
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Provider Business Mailing Address
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Address Line | 430 F ST
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City | CHULA VISTA
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State | CA
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Zip | 91910-3711
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Country | US
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Telephone | 619-420-3620
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Fax | 619-420-8722
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. VALERIE CENTENO
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Credential |
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Telephone | 619-420-3620
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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 | 251S00000X
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License Number State |
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