Provider Demographics
NPI:1528187986
Name:SAN DIEGO COUNTY MEDICAL SERVICES PROGRAM
Entity Type:Organization
Organization Name:SAN DIEGO COUNTY MEDICAL SERVICES PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-515-6555
Mailing Address - Street 1:8840 COMPLEX DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1497
Mailing Address - Country:US
Mailing Address - Phone:858-492-4422
Mailing Address - Fax:
Practice Address - Street 1:8840 COMPLEX DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1497
Practice Address - Country:US
Practice Address - Phone:858-492-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMIA3744016Medicaid
CAMIA3744016Medicaid