Provider Demographics
NPI:1053522987
Name:HSSA COUNTY OF SAN DIEGO
Entity type:Organization
Organization Name:HSSA COUNTY OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED VOCATIONAL NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:LARGION
Authorized Official - Middle Name:VERA
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:619-479-1463
Mailing Address - Street 1:6850 PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-7087
Mailing Address - Country:US
Mailing Address - Phone:619-479-1463
Mailing Address - Fax:
Practice Address - Street 1:3853 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN163754283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA163WP0809XMedicare ID - Type Unspecified