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General NPI Number Information
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NPI Number | 1679172290
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Entity Type | Organization
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Legal Business Name | CYTI HEALTH PC
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 402 W BROADWAY STE 400
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City | SAN DIEGO
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State | CA
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Zip | 92101-3554
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Country | US
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Telephone | 866-478-3978
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1310
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City | SHERWOOD
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State | OR
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Zip | 97140-1310
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Country | US
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Telephone | 503-625-0152
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DANIEL J. COSTA
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Credential |
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Telephone | 503-814-7445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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