MEDICARE: POINT LOMA CONVALESCENT HOSPITAL

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	314000000X	Skilled Nursing Facility		CA

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	4365879-8	OTHER	CA	STATE TAX I.D.

General Provider Information

NPI Number	:	1528055787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POINT LOMA CONVALESCENT HOSPITAL

Provider Business Mailing Address
First Line	:	3202 DUKE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5401
Country	:	US
Telephone Number	:	619-224-4141
Fax Number	:	619-224-1328

Provider Business Practice Location Address
First Line	:	3202 DUKE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5401
Country	:	US
Telephone Number	:	619-224-4141
Fax Number	:	619-224-1328

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	KITTY TEEL
Credential	:
Telephone Number	:	619-224-4141

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	08/22/2020

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