Provider Demographics
NPI:1285138230
Name:PATHFINDERS OF SAN DIEGO
Entity type:Organization
Organization Name:PATHFINDERS OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:VERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-818-1738
Mailing Address - Street 1:2621 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2809
Mailing Address - Country:US
Mailing Address - Phone:619-666-7826
Mailing Address - Fax:
Practice Address - Street 1:2952 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102
Practice Address - Country:US
Practice Address - Phone:619-239-7370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37006AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid