MEDICARE: COUNTY OF SAN DIEGO

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	251B00000X	Case Management Agency
2	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336209220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF SAN DIEGO

Provider Business Mailing Address
First Line	:	1250 MORENA BLVD
Second Line	:	1ST FLOOR
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3815
Country	:	US
Telephone Number	:	619-692-8750
Fax Number	:	619-692-8779

Provider Business Practice Location Address
First Line	:	1250 MORENA BLVD
Second Line	:	1ST FLOOR
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3815
Country	:	US
Telephone Number	:	619-692-8750
Fax Number	:	619-692-8779

Authorized Official
Title or Position	:	DIRECTOR,BEHAVIORAL HEALTH SERVICEC
Name	:	LUKE BERGMANN
Credential	:	PHD
Telephone Number	:	619-563-2700

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	09/05/2023

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Directions to “COUNTY OF SAN DIEGO ” Practice Location

Language	Start Address	Practice Location

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