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General NPI Number Information
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NPI Number | 1992306161
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Entity Type | Organization
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Legal Business Name | PRIME HEALTHCARE PARADISE VALLEY LLC
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 330 MOSS ST
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City | CHULA VISTA
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State | CA
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Zip | 91911-2005
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Country | US
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Telephone | 619-426-6310
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 E 4TH ST
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2026
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Country | US
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Telephone | 619-470-4321
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Fax |
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Authorized Official
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Title or Position | MANAGING ASSOCIATE GENERAL COUNSEL
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Name | CHRISTOPHER DOAN
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Credential |
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Telephone | 310-259-4706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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