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General NPI Number Information
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NPI Number | 1619426673
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Entity Type | Organization
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Legal Business Name | PACIFIC MEDICAL/BAY RECOVERY
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Dates
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Enumeration Date | 09/30/2016
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 1501 5TH AVE STE 200
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City | SAN DIEGO
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State | CA
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Zip | 92101-3224
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Country | US
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Telephone | 619-493-0436
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 5TH AVE STE 200
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City | SAN DIEGO
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State | CA
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Zip | 92101-3224
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Country | US
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Telephone | 619-493-0436
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Fax |
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Authorized Official
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Title or Position | HR MANAGER
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Name | JOSIE RAMOS
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Credential |
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Telephone | 619-592-8695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | IMF78197
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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