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5101 Market Street Suite 2300 San Diego CA 92114-2225 | |
| (858) 351-6000 | |
| (619) 595-7927 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5101 Market Street, San Diego, California |
| Authorized Official Name and Position | Luke Bergmann (DIRECTOR, BEHAVIORAL HEALTH SERVICE) |
| Authorized Official Contact | 6195632700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5101 Market Street Suite 2300 San Diego CA 92114-2225 Ph: (858) 351-6000 | 5101 Market Street Suite 2300 San Diego CA 92114-2225 Ph: (858) 351-6000 |
| NPI Number | 1386704351 |
|---|---|
| Provider Enumeration Date | 12/11/2006 |
| Last Update Date | 03/14/2024 |
| Certification Date | 03/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386704351 | NPI | - | NPPES |
| 3703 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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