Provider Demographics
NPI:1720343429
Name:SAN DIEGO COUNTY PSYCHIATRIC HOSPITAL
Entity Type:Organization
Organization Name:SAN DIEGO COUNTY PSYCHIATRIC HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN - PSYCH/MENTAL HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGBORN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:619-692-8232
Mailing Address - Street 1:3853 ROSECRANS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3115
Mailing Address - Country:US
Mailing Address - Phone:619-692-8232
Mailing Address - Fax:619-542-4060
Practice Address - Street 1:3853 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8232
Practice Address - Fax:619-542-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA163WP0809X283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital