Organization
PRIME HEALTHCARE, INC
Active
Other names
PRIME ALLY PROGRAM
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS LEON PH.D., P.A. (CEO)
(619) 470-4115
Entity
Organization
Contact information
Practice address
330 MOSS ST, CHULA VISTA, CA 91911-2005
(619) 472-4586
Mailing address
330 MOSS ST, CHULA VISTA, CA 91911-2005
(619) 472-4586
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
090000086
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37JW
COUNTY OF SAN DIEGO
CA
Enumeration date
05/15/2007
Last updated
08/14/2008
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