MEDICARE: SAN DIEGO CENTER FOR CHILDREN

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37OA	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1972898088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO CENTER FOR CHILDREN

Provider Business Mailing Address
First Line	:	2655 CAMINO DEL RIO N STE 450
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1603
Country	:	US
Telephone Number	:	858-633-4102
Fax Number	:	858-737-6972

Provider Business Practice Location Address
First Line	:	2655 CAMINO DEL RIO N STE 450
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1603
Country	:	US
Telephone Number	:	858-633-4102
Fax Number	:	858-737-6972

Authorized Official
Title or Position	:	QA DIRECTOR
Name	:	MISTY HOWARD
Credential	:
Telephone Number	:	858-569-2199

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	04/28/2023

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Directions to “SAN DIEGO CENTER FOR CHILDREN ” Practice Location

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