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General NPI Number Information
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NPI Number | 1689268294
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Entity Type | Organization
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Legal Business Name | LA JOLLA RECOVERY INC
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 1446, 1448 & 1450 DIAMOND ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-3023
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Country | US
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Telephone | 858-877-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 1804 GARNET AVE # 233
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City | SAN DIEGO
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State | CA
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Zip | 92109-3352
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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 | CEO
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Name | DANIEL SIMONS
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Credential |
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Telephone | 858-877-3422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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