Provider Demographics
NPI:1033360268
Name:EAST COUNTY MENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:EAST COUNTY MENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, LCSW
Authorized Official - Phone:619-401-5500
Mailing Address - Street 1:1000 BROADWAY AVE.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4638
Mailing Address - Country:US
Mailing Address - Phone:619-401-5500
Mailing Address - Fax:619-401-5454
Practice Address - Street 1:1000 BROADWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-7417
Practice Address - Country:US
Practice Address - Phone:619-401-5500
Practice Address - Fax:619-401-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service