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114 W Hall Ave San Ysidro CA 92173-2693 | |
| (619) 420-3620 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 114 W Hall Ave, San Ysidro, California |
| Authorized Official Name and Position | Stacey Musso (DEPARTMENT DIRECTOR) |
| Authorized Official Contact | 6194203620 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
430 F St Chula Vista CA 91910-3711 Ph: (619) 420-3620 | 114 W Hall Ave San Ysidro CA 92173-2693 Ph: (619) 420-3620 |
| NPI Number | 1538983507 |
|---|---|
| Provider Enumeration Date | 11/14/2024 |
| Last Update Date | 12/16/2024 |
| Certification Date | 12/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538983507 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Jr's Trauma Care Initiative Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1665 Precision Park Ln Ste H, San Ysidro, CA 92173 Phone: 619-330-7569 |