Basic Information
| Provider Information | |||||||||
| NPI: | 1386969046 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN DIEGO COUNTY HHSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6160 MISSION GORGE RD FL 4 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921203410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195284018 | ||||||||
| FaxNumber: | 6195284087 | ||||||||
| Practice Location | |||||||||
| Address1: | 6160 MISSION GORGE RD FL 4 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921203410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195284018 | ||||||||
| FaxNumber: | 6195284087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2010 | ||||||||
| LastUpdateDate: | 04/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | ROMANO-AUSTIN | ||||||||
| AuthorizedOfficialFirstName: | DIONNE | ||||||||
| AuthorizedOfficialMiddleName: | MENDOZA | ||||||||
| AuthorizedOfficialTitleorPosition: | CASE MANAGER COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 6195284018 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN, PHN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 588792 | CA | Y | Agencies | Case Management |
No ID Information.