Provider Demographics
NPI:1053022772
Name:THE STEVEN A. COHEN MILITARY FAMILY CLINIC AT VVSD, SAN DIEGO
Entity type:Organization
Organization Name:THE STEVEN A. COHEN MILITARY FAMILY CLINIC AT VVSD, SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RETUYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-840-0734
Mailing Address - Street 1:8885 RIO SAN DIEGO DR STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1610
Mailing Address - Country:US
Mailing Address - Phone:619-345-4611
Mailing Address - Fax:
Practice Address - Street 1:8885 RIO SAN DIEGO DR STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1610
Practice Address - Country:US
Practice Address - Phone:619-345-4611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIETNAM VETERANS OF SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)