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1715 31st St 3320 Kemper St. Suite3104 San Diego CA 92102-1425 | |
| (619) 758-6205 | |
| (619) 758-6209 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1715 31st St, San Diego, California |
| Authorized Official Name and Position | Joseph Michael Concellosi (PROGRAM MANAGER) |
| Authorized Official Contact | 6197586205 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1715 31st St 3320 Kemper St. Suite#104 San Diego CA 92102-1425 Ph: (619) 758-6205 | 1715 31st St 3320 Kemper St. Suite3104 San Diego CA 92102-1425 Ph: (619) 758-6205 |
| NPI Number | 1972632479 |
|---|---|
| Provider Enumeration Date | 03/02/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972632479 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LCS13561 (California) | Primary |
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