NPI 1356434112

County of San Diego

Organisation Exclusive Provider Organization San Diego, CA

Practice location

Address: 6991 Balboa Avenue, San Diego, CA 92111
Phone: (858) 496-8232
Fax: (858) 496-8234
Mailing address: 6160 Mission Gorge Road, San Diego, CA 92120

Authorised official

Name: Robyn Burns
Title: Chief
Phone: (619) 528-4082

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence CCS00042F (CA)

Other Exclusive Provider Organization providers in California →

Registry record

NPI: 1356434112
Entity type: Organization
NPI issued: 2 Oct 2006
Record last updated: 22 Aug 2020

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.