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4520 Executive Dr Suite 225 San Diego CA 92121-3018 | |
| (858) 202-1822 | |
| (858) 202-4421 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 4520 Executive Dr, San Diego, California |
| Authorized Official Name and Position | Krista Lydia Roybal (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8582021822 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4520 Executive Drive Suite 225 San Diego CA 92121 Ph: (858) 202-1822 | 4520 Executive Dr Suite 225 San Diego CA 92121-3018 Ph: (858) 202-1822 |
| NPI Number | 1093143430 |
|---|---|
| Provider Enumeration Date | 10/22/2013 |
| Last Update Date | 02/19/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093143430 | NPI | - | NPPES |
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