MEDICARE: UPAC TRC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013363035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPAC TRC

Provider Business Mailing Address
First Line	:	3288 EL CAJON BLVD STE 13
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-1430
Country	:	US
Telephone Number	:	619-521-5720
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 PARK BLVD
Second Line	:	BUILDING 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-4722
Country	:	US
Telephone Number	:	619-521-5720
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	COURTNEY BOATMAN
Credential	:	LMFT
Telephone Number	:	619-521-5720

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	09/12/2022

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Directions to “UPAC TRC ” Practice Location

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