Provider Demographics
NPI:1831318500
Name:DEVELOPMENTAL SPECIALISTS OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:DEVELOPMENTAL SPECIALISTS OF SOUTHERN CALIFORNIA
Other - Org Name:DSSC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MISHEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-581-5053
Mailing Address - Street 1:9320 CHESAPEAKE DR
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1029
Mailing Address - Country:US
Mailing Address - Phone:858-581-5053
Mailing Address - Fax:858-274-0348
Practice Address - Street 1:9320 CHESAPEAKE DR
Practice Address - Street 2:SUITE 214
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1029
Practice Address - Country:US
Practice Address - Phone:858-581-5053
Practice Address - Fax:858-274-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17217103TC0700X
CALCS220411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty