Provider Demographics
NPI:1689906851
Name:SAN DIEGO DEAF MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SAN DIEGO DEAF MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:858-410-1067
Mailing Address - Street 1:707 BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5391
Mailing Address - Country:US
Mailing Address - Phone:858-410-1067
Mailing Address - Fax:
Practice Address - Street 1:707 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5391
Practice Address - Country:US
Practice Address - Phone:858-410-1067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No302F00000XManaged Care OrganizationsExclusive Provider Organization