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General NPI Number Information
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NPI Number | 1982108841
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Entity Type | Organization
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Legal Business Name | PATHFINDERS OF SAN DIEGO
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 1530 DALE ST
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City | SAN DIEGO
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State | CA
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Zip | 92102-1519
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Country | US
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Telephone | 619-260-1605
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Fax |
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Provider Business Mailing Address
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Address Line | 2621 UNIVERSITY AVE
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City | SAN DIEGO
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State | CA
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Zip | 92104-2809
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Country | US
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Telephone | 619-260-1605
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | STEVEN GILBERT STANLEY
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Credential |
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Telephone | 619-666-7826
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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 | 370006AN
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License Number State | CA
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