NPI 1205401593
Jr's Trauma Care Initiative
Practice location
- Address
- 1665 Precision Park Ln STE H, San Ysidro, CA 92173-1348
- Phone
- (619) 330-7569
- Mailing address
- 654 E San Ysidro Blvd Unit 483, San Ysidro, CA 92173-3151
Authorised official
- Name
- Charles Elmer Walker
- Title
- Director of Mental Health
- Phone
- (619) 330-7569
Registered specialties (5)
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
Mental Health Counselor
Clinical Social Worker
Marriage & Family Therapist
Adolescent and Children Mental Health Clinic/Center
Registry record
- NPI
- 1205401593
- Entity type
- Organization
- NPI issued
- 20 May 2021
- Record last updated
- 20 May 2021
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.