| Impact | |
|
1202 Morena Blvd Suite 101 San Diego CA 92110-3841 | |
| (619) 398-0355 | |
| (619) 398-0355 |
| Full Name | Impact |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1202 Morena Blvd, San Diego, California |
| Authorized Official Name and Position | Bob Marchetti (CFO) |
| Authorized Official Contact | 6192750822 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact 1260 Morena Blvd Suite 100 San Diego CA 92110-3889 Ph: (619) 398-0355 | Impact 1202 Morena Blvd Suite 101 San Diego CA 92110-3841 Ph: (619) 398-0355 |
| NPI Number | 1740642008 |
|---|---|
| Provider Enumeration Date | 03/25/2016 |
| Last Update Date | 03/25/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740642008 | NPI | - | NPPES |
| 37JC | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 37JC (California) | Primary |
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