Provider Demographics
NPI:1336508621
Name:DISCOVERY PRACTICE MANAGEMENT, INC
Entity Type:Organization
Organization Name:DISCOVERY PRACTICE MANAGEMENT, INC
Other - Org Name:DEL MAR - OUTPATIENT
Other - Org Type:Other Name
Authorized Official - Title/Position:INSURANCE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:KERRYLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-828-1800
Mailing Address - Street 1:4281 KATELLA AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3510
Mailing Address - Country:US
Mailing Address - Phone:714-828-1800
Mailing Address - Fax:714-828-1868
Practice Address - Street 1:11455 CAMINO REAL
Practice Address - Street 2:STE 360
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:866-382-1306
Practice Address - Fax:714-388-3894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility