Provider Demographics
NPI:1396515789
Name:MCGINNESS, DAVID ROY
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROY
Last Name:MCGINNESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N JOHNSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1651
Mailing Address - Country:US
Mailing Address - Phone:760-994-3385
Mailing Address - Fax:
Practice Address - Street 1:200 E WASHINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1806
Practice Address - Country:US
Practice Address - Phone:760-741-7708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146D00000X
146L00000X, 146M00000X, 146N00000X, 171M00000X, 225800000X, 226000000X, 374K00000X
CAF4351321405300000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist Assistant
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No405300000XOther Service ProvidersPrevention Professional