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General NPI Number Information
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NPI Number | 1952797227
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Entity Type | Organization
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Legal Business Name | HHSA
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 367 N MAGNOLIA AVE
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City | EL CAJON
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State | CA
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Zip | 92020-3995
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Country | US
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Telephone | 619-401-3674
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Fax |
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Provider Business Mailing Address
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Address Line | 367 N MAGNOLIA AVE
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City | EL CAJON
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State | CA
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Zip | 92020-3995
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Country | US
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Telephone | 619-401-3674
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Fax |
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Authorized Official
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Title or Position | PHN
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Name | SUMMER ROSE LEAL
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Credential |
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Telephone | 619-401-3674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 847723
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License Number State | CA
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