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2655 Camino Del Rio N Ste 450 San Diego CA 92108-1603 | |
| (858) 633-4102 | |
| (858) 737-6972 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2655 Camino Del Rio N Ste 450, San Diego, California |
| Authorized Official Name and Position | Misty Howard (QA DIRECTOR) |
| Authorized Official Contact | 8585692199 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2655 Camino Del Rio N Ste 450 San Diego CA 92108-1603 Ph: (858) 633-4102 | 2655 Camino Del Rio N Ste 450 San Diego CA 92108-1603 Ph: (858) 633-4102 |
| NPI Number | 1972898088 |
|---|---|
| Provider Enumeration Date | 06/16/2011 |
| Last Update Date | 04/28/2023 |
| Certification Date | 04/28/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972898088 | NPI | - | NPPES |
| 37OA | Other | CA | MEDI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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