Provider Demographics
NPI:1831235837
Name:SAN DIEGO TREATMENT SERVICES
Entity type:Organization
Organization Name:SAN DIEGO TREATMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:619-519-2458
Mailing Address - Street 1:3940 HOME AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5952
Mailing Address - Country:US
Mailing Address - Phone:619-262-8000
Mailing Address - Fax:619-266-7405
Practice Address - Street 1:3940 HOME AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5952
Practice Address - Country:US
Practice Address - Phone:619-262-8000
Practice Address - Fax:619-266-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3707251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT15004FMedicare ID - Type UnspecifiedOTP TREATMENT