Provider Demographics
NPI:1427683788
Name:SAN DIEGO CENTER OF INDIVIDUAL AND FAMILY WELL-BEING INC.
Entity type:Organization
Organization Name:SAN DIEGO CENTER OF INDIVIDUAL AND FAMILY WELL-BEING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUZZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP
Authorized Official - Phone:617-459-5661
Mailing Address - Street 1:5811 ADOBE FALLS RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4672
Mailing Address - Country:US
Mailing Address - Phone:617-459-5661
Mailing Address - Fax:619-535-0222
Practice Address - Street 1:4025 CAMINO DEL RIO S STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4108
Practice Address - Country:US
Practice Address - Phone:619-542-7745
Practice Address - Fax:619-535-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)