institution
Duangtavan Sourivong
Methadone Clinic in San Diego, California
NPI 1285821389

Duangtavan Sourivong is a Methadone Clinic based in San Diego, CA and is specialized in Methadone. Duangtavan Sourivong practices in San Diego, CA. The NPI Number for Duangtavan Sourivong is 1285821389 and holds a License No. (California).

The current practice location address for Duangtavan Sourivong is 3940 Home Ave, San Diego, CA and can be reached out via phone at 619-262-8000. You can also correspond with Duangtavan Sourivong through the mailing address at 4852 JARRETT CT, SAN DIEGO, CA - 92113-3598 (mailing address contact number: ).

Location: 3940 Home Ave, San Diego, CA, 92113-3598
institution
Provider Profile Details
NPI Number
1285821389
Provider Name
Duangtavan Sourivong
Credential
Provider Entity Type
Organization
Address
3940 Home Ave, San Diego, CA, 92113-3598
Phone Number
619-262-8000
Fax Number
Provider Enumeration Date
10/02/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
3940 Home Ave
City
State
Zip
92105-5952
Phone Number
619-262-8000
Fax Number
person
Provider Business Mailing Address Details
Address
4852 Jarrett Ct
City
State
Zip
92113-3598
Phone Number
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Methadone
Taxonomy
License No.
(California)
Definition
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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