Provider Demographics
NPI:1669864245
Name:UCSD HEALTH SYSTEM
Entity Type:Organization
Organization Name:UCSD HEALTH SYSTEM
Other - Org Name:UCSD SENIOR BEHAVIORAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF, CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-534-2827
Mailing Address - Street 1:410 DICKINSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6902
Mailing Address - Country:US
Mailing Address - Phone:619-471-3877
Mailing Address - Fax:619-471-9139
Practice Address - Street 1:410 DICKINSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6902
Practice Address - Country:US
Practice Address - Phone:619-471-3877
Practice Address - Fax:619-471-9139
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UCSD HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-19
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty