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2772 4th Ave San Diego CA 92103-6206 | |
| (619) 295-6067 | |
| (619) 295-6047 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2772 4th Ave, 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 |
|---|---|
2772 4th Ave San Diego CA 92103-6206 Ph: (619) 295-6067 | 2772 4th Ave San Diego CA 92103-6206 Ph: (619) 295-6067 |
| NPI Number | 1730302928 |
|---|---|
| Provider Enumeration Date | 04/10/2007 |
| Last Update Date | 07/29/2021 |
| Certification Date | 07/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730302928 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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