1114381969 NPI number — SWEETWATER UNION HIGH SCHOOL DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114381969 NPI number — SWEETWATER UNION HIGH SCHOOL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWEETWATER UNION HIGH SCHOOL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SWEETWATER OUTPATIENT CLINIC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114381969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 5TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91911-2812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-407-4920
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1051 PICADOR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92154-3548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-662-8372
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
R. VERNON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OF EDUCATIONAL EQUITY
Authorized Official Telephone Number:
619-407-4933

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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