Provider Demographics
NPI:1770265043
Name:SAN DIEGO HEALTH GROUP INC
Entity type:Organization
Organization Name:SAN DIEGO HEALTH GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUKHANA
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:619-647-8854
Mailing Address - Street 1:353 E PARK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3944
Mailing Address - Country:US
Mailing Address - Phone:619-914-4222
Mailing Address - Fax:619-914-0012
Practice Address - Street 1:353 E PARK AVE STE 102
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3944
Practice Address - Country:US
Practice Address - Phone:619-914-4222
Practice Address - Fax:619-914-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center