Provider Demographics
NPI:1396898474
Name:COUNTY O SAN DIEGO
Entity type:Organization
Organization Name:COUNTY O SAN DIEGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BEHAVIOR HEALTH SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-563-2700
Mailing Address - Street 1:5101 MARKET STREET
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-2225
Mailing Address - Country:US
Mailing Address - Phone:858-694-4680
Mailing Address - Fax:858-694-4492
Practice Address - Street 1:5101 MARKET STREET
Practice Address - Street 2:SUITE 2100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-2225
Practice Address - Country:US
Practice Address - Phone:619-577-0231
Practice Address - Fax:858-694-4492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3793Medicaid