Organization
COASTAL DETOX OF SOUTHERN CALIFORNIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERCEDES CORNEJO (CEO)
(619) 386-7740
Entity
Organization
Contact information
Practice address
2574 PICO WAY, SAN DIEGO, CA 92109-3811
(619) 386-7740
Mailing address
2574 PICO WAY, SAN DIEGO, CA 92109-3811
(619) 386-7740
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370207AP
DHCS
CA
Enumeration date
08/31/2022
Last updated
05/30/2025
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