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General NPI Number Information
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NPI Number | 1841911781
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Entity Type | Organization
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Legal Business Name | SAN DIEGO DETOX LLC
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Dates
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Enumeration Date | 09/08/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 16925 DEER HILL ESTS
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City | LAKESIDE
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State | CA
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Zip | 92040-1101
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Country | US
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Telephone | 619-433-4971
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Fax |
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Provider Business Mailing Address
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Address Line | 3952D CLAIREMONT MESA BLVD STE 373
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City | SAN DIEGO
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State | CA
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Zip | 92117-2714
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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 | DIRECTOR
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Name | ALISON LITTON
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Credential |
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Telephone | 619-433-4971
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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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