Provider Demographics
NPI:1124594817
Name:CENTER FOR COMMUNITY INTEGRATION SAN DIEGO
Entity Type:Organization
Organization Name:CENTER FOR COMMUNITY INTEGRATION SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STARLIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-254-2771
Mailing Address - Street 1:6602 EL CAJON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2803
Mailing Address - Country:US
Mailing Address - Phone:619-254-2771
Mailing Address - Fax:
Practice Address - Street 1:6602 EL CAJON BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-2803
Practice Address - Country:US
Practice Address - Phone:619-254-2771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)