Basic Information
| Provider Information | |||||||||
| NPI: | 1053522987 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HSSA COUNTY OF SAN DIEGO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6850 PLAZA BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921147087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194791463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3853 ROSECRANS ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196928200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SORIANO | ||||||||
| AuthorizedOfficialFirstName: | LARGION | ||||||||
| AuthorizedOfficialMiddleName: | VERA | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED VOCATIONAL NURSE | ||||||||
| AuthorizedOfficialTelephone: | 6194791463 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LVN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | VN163754 | CA | Y | Hospitals | Psychiatric Hospital |
No ID Information.