Provider Demographics
NPI:1740340066
Name:SAN DIEGO COUNTY POLINSKY CHILDRENS CENTER
Entity type:Organization
Organization Name:SAN DIEGO COUNTY POLINSKY CHILDRENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:858-966-4941
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MC5036
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-4941
Mailing Address - Fax:
Practice Address - Street 1:9400 RUFFIN CT
Practice Address - Street 2:BUILDING B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-5300
Practice Address - Country:US
Practice Address - Phone:858-966-4941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70469FMedicaid