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Organization subpart
No

Provider details

NPI number
Authorized official
GERRIE FENTON (PROGRAM COORDINATOR)
(619) 328-0954
Entity
Organization

Contact information

Practice address
131 AVOCADO AVE, EL CAJON, CA 92020
(619) 692-0727
(619) 692-0785
Mailing address
3003 E MAIN STREET, EL CAJON, CA 92020
(619) 692-0727
(619) 692-0785

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary

Other

Enumeration date
12/07/2015
Last updated
12/07/2015
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