| South Bay Impact | |
|
855 3rd Ave Ste 1110 Chula Vista CA 91911-1350 | |
| (619) 934-5770 | |
| Not Available |
| Full Name | South Bay Impact |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 855 3rd Ave Ste 1110, Chula Vista, California |
| Authorized Official Name and Position | Jack Farmer (CHIEF ADMINISTRATIVE OFFICER) |
| Authorized Official Contact | 6192750822 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Bay Impact 1202 Morena Blvd San Diego CA 92110-3841 Ph: () - | South Bay Impact 855 3rd Ave Ste 1110 Chula Vista CA 91911-1350 Ph: (619) 934-5770 |
| NPI Number | 1326551490 |
|---|---|
| Provider Enumeration Date | 11/13/2017 |
| Last Update Date | 12/05/2022 |
| Certification Date | 12/05/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326551490 | NPI | - | NPPES |
| 37RR | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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