Provider Demographics
NPI:1932134921
Name:PLANNED PARENTHOOD PACIFIC SOUTHWEST
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD PACIFIC SOUTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-881-4500
Mailing Address - Street 1:1075 CAMINO DEL RIO S
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3538
Mailing Address - Country:US
Mailing Address - Phone:619-881-4500
Mailing Address - Fax:
Practice Address - Street 1:1333 CAMINO DEL RIO S STE 306
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3520
Practice Address - Country:US
Practice Address - Phone:619-881-4594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM71052FMedicaid