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General NPI Number Information
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NPI Number | 1659824712
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Entity Type | Organization
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Legal Business Name | PHASES INTEGRATION PROGRAM, LLC
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 810 EMERALD ST #101
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City | SAN DIEGO
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State | CA
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Zip | 92109-2712
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Country | US
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Telephone | 858-345-7422
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Fax |
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Provider Business Mailing Address
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Address Line | 13424 TIVERTON RD
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City | SAN DIEGO
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State | CA
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Zip | 92130-1021
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Country | US
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Telephone | 858-345-7422
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANA SHATERIAN
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Credential |
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Telephone | 858-345-7422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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