1023103595 NPI number — COUNTY OF SAN DIEGO

Table of content: (NPI 1023103595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023103595 NPI number — COUNTY OF SAN DIEGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SAN DIEGO
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:
Provider Other Organization Name Type Code:
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:
1023103595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6160 MISSION GORGE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-528-4000
Provider Business Mailing Address Fax Number:
619-528-4077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 CAROLINA LANE
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:
92102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-262-7342
Provider Business Practice Location Address Fax Number:
619-262-8918
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
ROBYN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
619-528-4082

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  CCS00041F , 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)

  • Identifier: CCS00041F . This is a "MEDI-CAL PROVIDER NUMBERS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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