Provider Demographics
NPI:1760048086
Name:INFO LINE OF SAN DIEGO
Entity Type:Organization
Organization Name:INFO LINE OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:REDFERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-380-5263
Mailing Address - Street 1:PO BOX 420039
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92142-0039
Mailing Address - Country:US
Mailing Address - Phone:858-380-5263
Mailing Address - Fax:
Practice Address - Street 1:3860 CALLE FORTUNADA STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4802
Practice Address - Country:US
Practice Address - Phone:858-300-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare