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General NPI Number Information
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NPI Number | 1770756546
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Entity Type | Individual
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Provider Name | DAISY RUTH POMILIA
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Gender | Female
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 6154 MISSION GORGE RD 120
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City | SAN DIEGO
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State | CA
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Zip | 92120-3493
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Country | US
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Telephone | 619-285-1718
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Fax |
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Provider Business Mailing Address
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Address Line | 1849 K AVE
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City | NATIONAL CITY
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State | CA
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Zip | 91950-5908
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Country | US
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Telephone | 619-474-2390
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 370069MN
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License Number State | CA
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