Provider Demographics
NPI:1174148639
Name:UNIVERSAL HEALTH NET SAN DIEGO
Entity type:Organization
Organization Name:UNIVERSAL HEALTH NET SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPCS/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMENEH ABUSAFIEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUSAFIEH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:949-690-5224
Mailing Address - Street 1:12 HOLLYLEAF
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2130
Mailing Address - Country:US
Mailing Address - Phone:949-690-5224
Mailing Address - Fax:
Practice Address - Street 1:4755 OCEANSIDE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3056
Practice Address - Country:US
Practice Address - Phone:760-957-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based