Provider Demographics
NPI:1326139742
Name:SDVA HEATHCARE SYSTEM
Entity Type:Organization
Organization Name:SDVA HEATHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:CASTELLI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:619-400-5200
Mailing Address - Street 1:13338 VIA MAGDALENA
Mailing Address - Street 2:#1
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129
Mailing Address - Country:US
Mailing Address - Phone:858-254-3689
Mailing Address - Fax:
Practice Address - Street 1:8810 RIO SAN DIEGO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1622
Practice Address - Country:US
Practice Address - Phone:619-400-5200
Practice Address - Fax:619-400-5171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291997283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital