Organization · Type 2 NPI

Duangtavan Sourivong

Methadone Clinic · San Diego, CA

NPI number 1285821389 Active

Practice location

3940 Home Ave
San Diego, CA 92105-5952

Call (619) 262-8000 Map

Mailing address

4852 Jarrett Ct
San Diego, CA 92113-3598

Specialties and licenses

TaxonomyCodeLicense
Methadone Clinic Primary 261QM2800XNone listed

Methadone Clinic: An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

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About NPI 1285821389

Duangtavan Sourivong's National Provider Identifier is 1285821389, issued on Oct 2, 2007. The primary taxonomy on file is Methadone Clinic (261QM2800X), and the practice location is in San Diego, CA. The record was last updated on Oct 2, 2007.