MEDICARE: UNITED CEREBRAL PALSY ASSOCIATION OF SAN DIEGO COUNTY

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1487148326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED CEREBRAL PALSY ASSOCIATION OF SAN DIEGO COUNTY

Provider Business Mailing Address
First Line	:	8525 GIBBS DR STE 209
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1765
Country	:	US
Telephone Number	:	858-571-7803
Fax Number	:	858-571-0919

Provider Business Practice Location Address
First Line	:	8665 GIBBS DRIVE
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1765
Country	:	US
Telephone Number	:	858-571-7803
Fax Number	:	858-571-0919

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DAVID STEVEN CARUCCI
Credential	:
Telephone Number	:	858-571-7803

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	06/18/2018

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Directions to “UNITED CEREBRAL PALSY ASSOCIATION OF SAN DIEGO COUNTY ” Practice Location

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