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General NPI Number Information
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NPI Number | 1922979053
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Entity Type | Organization
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Legal Business Name | EMPOWERED COMMUNITY MANAGEMENT
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 3911 CLEVELAND AVE # 33748
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City | SAN DIEGO
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State | CA
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Zip | 92103-3402
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Country | US
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Telephone | 805-386-9712
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Fax |
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Provider Business Mailing Address
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Address Line | 3911 CLEVELAND AVE # 33748
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City | SAN DIEGO
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State | CA
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Zip | 92103-3402
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Country | US
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Telephone | 805-680-2774
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Fax |
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | MR. REYNALDO LARA JR.
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Credential |
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Telephone | 805-680-2774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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