Provider Demographics
NPI:1962531889
Name:POLINSKY CHILDREN'S CENTER
Entity type:Organization
Organization Name:POLINSKY CHILDREN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR, MENTAL HEALTH SRVS
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-563-2711
Mailing Address - Street 1:9400 RUFFIN CT
Mailing Address - Street 2:B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-5300
Mailing Address - Country:US
Mailing Address - Phone:858-514-4600
Mailing Address - Fax:858-514-4634
Practice Address - Street 1:9400 RUFFIN CT
Practice Address - Street 2:B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-5300
Practice Address - Country:US
Practice Address - Phone:858-514-4600
Practice Address - Fax:858-514-4634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37B6Medicaid