Basic Information
| Provider Information | |||||||||
| NPI: | 1720343429 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN DIEGO COUNTY PSYCHIATRIC HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3853 ROSECRANS ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196928232 | ||||||||
| FaxNumber: | 6195424060 | ||||||||
| Practice Location | |||||||||
| Address1: | 3853 ROSECRANS ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196928232 | ||||||||
| FaxNumber: | 6195424060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2012 | ||||||||
| LastUpdateDate: | 07/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | VIGBORN | ||||||||
| AuthorizedOfficialFirstName: | ARI | ||||||||
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| AuthorizedOfficialTitleorPosition: | RN - PSYCH/MENTAL HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 6196928232 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | REGISTERED NURSE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 163WP0809X | CA | Y | Hospitals | Psychiatric Hospital |
No ID Information.