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General NPI Number Information
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NPI Number | 1609122423
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Entity Type | Organization
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Legal Business Name | YOUTH JUSTICE INSTITUTE
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 375 WOODSIDE AVE W2
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City | SAN FRANCISCO
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State | CA
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Zip | 94127-1221
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Country | US
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Telephone | 415-753-7662
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Fax | 415-753-7662
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Provider Business Mailing Address
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Address Line | PO BOX 31733
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City | SAN FRANCISCO
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State | CA
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Zip | 94131-0733
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Country | US
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Telephone | 415-753-7662
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Fax | 415-753-4464
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. GENA CASTRO RODRIGUEZ
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Credential | LFMT
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Telephone | 415-753-7670
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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 | MFC 49717
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License Number State | CA
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