Provider Demographics
NPI:1487148326
Name:UNITED CEREBRAL PALSY ASSOCIATION OF SAN DIEGO COUNTY
Entity type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOCIATION OF SAN DIEGO COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:CARUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-571-7803
Mailing Address - Street 1:8525 GIBBS DR STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1765
Mailing Address - Country:US
Mailing Address - Phone:858-571-7803
Mailing Address - Fax:858-571-0919
Practice Address - Street 1:8665 GIBBS DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1765
Practice Address - Country:US
Practice Address - Phone:858-571-7803
Practice Address - Fax:858-571-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty