Provider Demographics
NPI:1457804635
Name:SOUTH BAY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:SOUTH BAY COMMUNITY SERVICES
Other - Org Name:MI ESCUELITA
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CENTENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-420-3620
Mailing Address - Street 1:430 F ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3711
Mailing Address - Country:US
Mailing Address - Phone:619-420-3620
Mailing Address - Fax:
Practice Address - Street 1:915 4TH AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2083
Practice Address - Country:US
Practice Address - Phone:619-420-7071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37LAMedicaid