MEDICARE: INFO LINE 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	251K00000X	Public Health or Welfare Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1760048086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFO LINE OF SAN DIEGO

Provider Business Mailing Address
First Line	:	PO BOX 420039
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92142-0039
Country	:	US
Telephone Number	:	858-380-5263
Fax Number	:

Provider Business Practice Location Address
First Line	:	3860 CALLE FORTUNADA STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4802
Country	:	US
Telephone Number	:	858-300-1211
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	PAUL REDFERN
Credential	:
Telephone Number	:	858-380-5263

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	05/13/2019

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Directions to “INFO LINE OF SAN DIEGO ” Practice Location

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