Basic Information
| Provider Information | |||||||||
| NPI: | 1568893212 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY RESEARCH FOUNDATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PERT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 421141 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921421141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192768112 | ||||||||
| FaxNumber: | 6192768230 | ||||||||
| Practice Location | |||||||||
| Address1: | 5215 GAINES ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921102639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192768112 | ||||||||
| FaxNumber: | 6192768230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2013 | ||||||||
| LastUpdateDate: | 10/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | MARCHETTI | ||||||||
| AuthorizedOfficialFirstName: | BOB | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6192750822 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 37B7 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.