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General NPI Number Information
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NPI Number | 1639907272
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Entity Type | Organization
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Legal Business Name | SAN DIEGO REHAB
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Dates
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Enumeration Date | 07/24/2024
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 430 NUTMEG ST STE 200
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City | SAN DIEGO
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State | CA
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Zip | 92103-6261
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Country | US
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Telephone | 310-343-8684
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Fax |
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Provider Business Mailing Address
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Address Line | 430 NUTMEG ST STE 200
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City | SAN DIEGO
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State | CA
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Zip | 92103-6261
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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 | MANAGER
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Name | NATHAN YOUNG
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Credential |
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Telephone | 310-343-8684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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