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General NPI Number Information
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NPI Number | 1518799634
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Entity Type | Organization
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Legal Business Name | WINDANSEA RECOVERY LLC
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Dates
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Enumeration Date | 08/16/2024
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 5639 LA JOLLA BLVD
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City | LA JOLLA
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State | CA
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Zip | 92037-7524
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Country | US
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Telephone | 619-857-3089
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3395
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City | LA JOLLA
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State | CA
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Zip | 92038-3395
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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 | OWNER
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Name | GINO GALOFARO
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Credential |
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Telephone | 619-728-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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