Duangtavan Sourivong
Duangtavan Sourivong is a Methadone Clinic in San Diego, California. Licensed in California. Registered with an NPI since 2007.
- Licensed in
- CA
- In the registry since
- 2007
Practice location Address checks out
3940 Home AveSan Diego, CA 92105-5952
Phone: (619) 262-8000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Methadone Clinic (primary) | Taxonomy 261QM2800X (CA) |
|---|
Record details
| NPI number | 1285821389 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Bobby Stearns — Clinic Director · (619) 262-8000 |
| NPI enumerated | October 2, 2007 |
| Last updated in NPPES | October 2, 2007 |
| Mailing address | 4852 Jarrett Ct, San Diego, CA 92113-3598 |
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