Provider Demographics
NPI:1780787747
Name:SAN DIEGO HEALTH ALLIANCE
Entity type:Organization
Organization Name:SAN DIEGO HEALTH ALLIANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:6183 PASEO DEL NORTE
Mailing Address - Street 2:STE 200
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1151
Mailing Address - Country:US
Mailing Address - Phone:855-259-2288
Mailing Address - Fax:
Practice Address - Street 1:1560 CAPALINA CLINIC
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069
Practice Address - Country:US
Practice Address - Phone:760-744-2104
Practice Address - Fax:760-744-1382
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN DIEGO HEALTH ALLIANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3714261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8778Medicaid
CA8778Medicaid