Provider Demographics
NPI:1760632699
Name:SOUTH BAY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:SOUTH BAY COMMUNITY SERVICES
Other - Org Name:SCHOOL BASED PROGRAMS
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM MAMAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:GUADALUPE
Authorized Official - Last Name:CENTENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-420-3620
Mailing Address - Street 1:196 LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2518
Mailing Address - Country:US
Mailing Address - Phone:619-420-3620
Mailing Address - Fax:619-420-8722
Practice Address - Street 1:2001 RIMBEY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-3032
Practice Address - Country:US
Practice Address - Phone:619-420-3620
Practice Address - Fax:619-420-8722
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH BAY COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-29
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency