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General NPI Number Information
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NPI Number | 1619279361
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Entity Type | Organization
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Legal Business Name | PQ OUTREACH COALITION
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 10060 CARMEL MOUNTAIN RD
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City | SAN DIEGO
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State | CA
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Zip | 92129-3228
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Country | US
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Telephone | 858-206-1860
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Fax | 858-484-8577
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Provider Business Mailing Address
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Address Line | 10060 CARMEL MOUNTAIN RD
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City | SAN DIEGO
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State | CA
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Zip | 92129-3228
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Country | US
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Telephone | 858-206-1860
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Fax | 858-484-8577
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Authorized Official
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Title or Position | CHAIR BOARD OF DIRECTORS
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Name | DR. WILLIAM KENNETH HARMANING
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Credential | ED.D.
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Telephone | 858-206-1860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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