Provider Demographics
NPI:1093177099
Name:LA JOLLA ADDICTION HEALING CENTER
Entity Type:Organization
Organization Name:LA JOLLA ADDICTION HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-775-7752
Mailing Address - Street 1:7590 FAY AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4872
Mailing Address - Country:US
Mailing Address - Phone:858-775-7752
Mailing Address - Fax:
Practice Address - Street 1:7590 FAY AVE STE 404
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4872
Practice Address - Country:US
Practice Address - Phone:858-775-7752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18549404101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty