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3660 Fairmount Ave San Diego CA 92105-3422 | |
| (619) 521-2250 | |
| (619) 521-5944 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3660 Fairmount Ave, San Diego, California |
| Authorized Official Name and Position | Walter Edwin Philips (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6192218600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3255 Wing St San Diego CA 92110-4638 Ph: (619) 221-8600 | 3660 Fairmount Ave San Diego CA 92105-3422 Ph: (619) 521-2250 |
| NPI Number | 1689195398 |
|---|---|
| Provider Enumeration Date | 07/03/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689195398 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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