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General NPI Number Information
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NPI Number | 1740665108
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Entity Type | Organization
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Legal Business Name | SAN DIEGO BRAIN INJURY FOUNDATION
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 2033 ORO VERDE RD
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City | ESCONDIDO
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State | CA
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Zip | 92027-4810
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Country | US
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Telephone | 760-480-7468
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Fax | 760-741-6073
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Provider Business Mailing Address
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Address Line | PO BOX 84601
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City | SAN DIEGO
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State | CA
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Zip | 92138-4601
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Country | US
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Telephone | 619-294-6541
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Fax | 619-294-2911
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Authorized Official
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Title or Position | COO
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Name | SUSAN HANSEN
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Credential |
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Telephone | 619-294-6541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 372002856
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License Number State | CA
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