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6244 El Cajon Blvd Suite 14 San Diego CA 92115-3918 | |
| (619) 640-3266 | |
| (619) 640-3269 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6244 El Cajon Blvd, San Diego, California |
| Authorized Official Name and Position | Tracy Ginter (DIRECTOR OF STATE OPERATIONS) |
| Authorized Official Contact | 6574659497 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8337 Telegraph Rd Ste 300 Pico Rivera CA 90660-4957 Ph: (562) 467-5440 | 6244 El Cajon Blvd Suite 14 San Diego CA 92115-3918 Ph: (619) 640-3266 |
| NPI Number | 1033239777 |
|---|---|
| Provider Enumeration Date | 03/29/2007 |
| Last Update Date | 06/03/2024 |
| Certification Date | 06/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033239777 | NPI | - | NPPES |
| 37FF | Other | CA | MEDI-CAL PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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