Organization
COUNTY OF SAN DIEGO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROBYN BURNS (CHIEF)
(619) 528-4082
Entity
Organization
Contact information
Practice address
6991 BALBOA AVENUE, SAN DIEGO, CA 92111
(858) 496-8232
(858) 496-8234
Mailing address
6160 MISSION GORGE ROAD, SAN DIEGO, CA 92120
(619) 528-4000
(619) 528-4077
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
CCS00042F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CCS00042F
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
10/02/2006
Last updated
08/22/2020
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