Provider Demographics
NPI:1629164322
Name:COUNTY OF SAN DIEGO
Entity Type:Organization
Organization Name:COUNTY OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-528-4082
Mailing Address - Street 1:6160 MISSION GORGE ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120
Mailing Address - Country:US
Mailing Address - Phone:619-528-4000
Mailing Address - Fax:619-528-4077
Practice Address - Street 1:420 NORTH FALCONER ROAD
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027
Practice Address - Country:US
Practice Address - Phone:760-432-2296
Practice Address - Fax:760-432-9419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACCS00105F302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACCS000105FOtherMEDI-CAL PROVIDER NUMBER