1306042668 NPI number — SAN DIEGO INSTITUTE FOR PREVENTION AND WELLNESS

Table of content: (NPI 1306042668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306042668 NPI number — SAN DIEGO INSTITUTE FOR PREVENTION AND WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN DIEGO INSTITUTE FOR PREVENTION AND WELLNESS
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:
1306042668
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:
8008 FROST ST
Provider Second Line Business Mailing Address:
SUITE 406
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-4205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-505-9438
Provider Business Mailing Address Fax Number:
858-613-0373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8008 FROST ST
Provider Second Line Business Practice Location Address:
SUITE 406
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-4205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-505-9438
Provider Business Practice Location Address Fax Number:
858-613-0373
Provider Enumeration Date:
06/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAXTER-JONES
Authorized Official First Name:
ROSALYN
Authorized Official Middle Name:
PTRICE
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
858-505-9438

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  G54625 , 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)





Copyright © 2007-2025 www.npivalidator.com