Provider Demographics
NPI:1689773228
Name:ACESS TO SAN DIEGO
Entity Type:Organization
Organization Name:ACESS TO SAN DIEGO
Other - Org Name:THE ACCESS CENTER SPOKE SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF BUSINESS ENTERPRISES
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:DECIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-296-8012
Mailing Address - Street 1:1295 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3333
Mailing Address - Country:US
Mailing Address - Phone:619-296-8012
Mailing Address - Fax:619-296-5269
Practice Address - Street 1:1295 UNIVERSITY AVE STE 2
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3333
Practice Address - Country:US
Practice Address - Phone:619-296-8012
Practice Address - Fax:619-296-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101302332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00068FMedicaid
CADME00068FMedicaid