Organization
SPACIENDA
Active
Organization
SPACIENDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBEKAH ABRAHIM (OWNER)
(619) 389-2047
Entity
Organization
Contact information
Practice address
5222 BALBOA AVE STE 43, SAN DIEGO, CA 92117-6956
(619) 389-2047
Mailing address
975 THERMAL AVE, SAN DIEGO, CA 92154-1924
(619) 261-3434
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
08/02/2023
Last updated
08/02/2023
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