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NPI Code Detail

MEDICARE: SOCIAL ADVOCATES FOR YOUTH SAN DIEGO, INC.

MEDICARE: SOCIAL ADVOCATES FOR YOUTH SAN DIEGO, INC.
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1043391923
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOCIAL ADVOCATES FOR YOUTH SAN DIEGO, INC.
Provider Business Mailing Address
First Line : 4775 VIEWRIDGE AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1641
Country : US
Telephone Number : 858-565-4148
Fax Number : 858-565-4178
Provider Business Practice Location Address
First Line : 4775 VIEWRIDGE AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1641
Country : US
Telephone Number : 858-565-4148
Fax Number : 858-565-4178
Authorized Official
Title or Position : VICE PRESIDENT
Name : KELLY ANN VALES
Credential :
Telephone Number : 619-283-9624
Provider Enumeration Date : 10/18/2006
Last Update Date : 02/06/2020

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Directions to “SOCIAL ADVOCATES FOR YOUTH SAN DIEGO, INC. ” Practice Location

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