Provider Demographics
NPI: | 1386969046 |
---|---|
Name: | SAN DIEGO COUNTY HHSA |
Entity type: | Organization |
Organization Name: | SAN DIEGO COUNTY HHSA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CASE MANAGER COORDINATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | DIONNE |
Authorized Official - Middle Name: | MENDOZA |
Authorized Official - Last Name: | ROMANO-AUSTIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN, PHN |
Authorized Official - Phone: | 619-528-4018 |
Mailing Address - Street 1: | 6160 MISSION GORGE RD FL 4 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN DIEGO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92120-3410 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 619-528-4018 |
Mailing Address - Fax: | 619-528-4087 |
Practice Address - Street 1: | 6160 MISSION GORGE RD FL 4 |
Practice Address - Street 2: | |
Practice Address - City: | SAN DIEGO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92120-3410 |
Practice Address - Country: | US |
Practice Address - Phone: | 619-528-4018 |
Practice Address - Fax: | 619-528-4087 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-04-06 |
Last Update Date: | 2010-04-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 588792 | 251B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251B00000X | Agencies | Case Management |