Individual
GWENDOLYN MARIE HAMILTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RADT1
Contact information
Practice address
2516 A ST, SAN DIEGO, CA 92102-2111
(619) 235-0592
Mailing address
2516 A ST, SAN DIEGO, CA 92102-2111
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
324500000X
THE WAY BACK
CA
Enumeration date
02/11/2019
Last updated
02/11/2019
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