Provider Demographics
NPI:1184836215
Name:COUNTY OF SAN DIEGO, AGING & INDEPENDANCE SERVICES
Entity Type:Organization
Organization Name:COUNTY OF SAN DIEGO, AGING & INDEPENDANCE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR TEAM
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCGVIEN
Authorized Official - Suffix:I
Authorized Official - Credentials:MFT
Authorized Official - Phone:760-739-6152
Mailing Address - Street 1:4858 DEL MAR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107
Mailing Address - Country:US
Mailing Address - Phone:760-739-6152
Mailing Address - Fax:760-739-6154
Practice Address - Street 1:4858 DEL MAR AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107
Practice Address - Country:US
Practice Address - Phone:760-739-6152
Practice Address - Fax:760-739-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36490251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health