Organization
MANUFEST MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR GROVE (CHIEF EXECUTIVE OFFICER)
(619) 752-4395
Entity
Organization
Contact information
Practice address
2300 BOSWELL RD, CHULA VISTA, CA 91914-3523
(619) 807-8223
Mailing address
PO BOX 371111, SAN DIEGO, CA 92137-1111
(619) 807-8223
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
02/17/2025
Last updated
02/24/2025
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