Organization
SAN DIEGO COUNTY MEDICAL SERVICES PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY HOGAN (CHIEF FINANCIAL OFFICER)
(619) 515-6555
Entity
Organization
Contact information
Practice address
8840 COMPLEX DR, SUITE 300, SAN DIEGO, CA 92123-1497
(858) 492-4422
Mailing address
8840 COMPLEX DR, SUITE 300, SAN DIEGO, CA 92123-1497
(858) 492-4422
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MIC373020
—
CA
Enumeration date
03/28/2007
Last updated
08/22/2020
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