NPIMap

Organization Active NPI

Upac TRC

  • Community/Behavioral Health Agency
  • San Diego, CA
National Provider Identifier
1013363035
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
UPAC TRC
Practice address
1405 Park Blvd
Building 100
San Diego, CA 92101-4722
Phone
(619) 521-5720
NPI assigned
May 9, 2016
Organization subpart
Yes
Parent organization
UNION OF PAN ASIAN COMMUNITIESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Courtney Boatman, LMFT
Title
Program Director
Phone
(619) 521-5720

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1405 Park Blvd
Building 100
San Diego, CA 92101-4722

Mailing address

3288 El Cajon Blvd Ste 13
San Diego, CA 92104-1430
Phone (619) 521-5720

Other identifiers 1

IdentifierTypeStateIssuer
8585MedicaidCA

Other names 1

  • SAN DIEGO HIGH Other name

National Provider Directory

National Provider Directory
Tax ID family
Upac Teen Recovery Center25 organizations share this tax ID, including this one
Part of
Upac Teen Recovery Center

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Locations

1405 Park Blvd
Bldg 100
San Diego, CA 92101

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662940800000",
    "number": "1013363035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3288 EL CAJON BLVD STE 13",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921041430",
            "telephone_number": "619-521-5720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 PARK BLVD",
            "address_2": "BUILDING 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921014722",
            "telephone_number": "619-521-5720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPAC TRC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNION OF PAN ASIAN COMMUNITIES",
        "enumeration_date": "2016-05-09",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A",
        "authorized_official_last_name": "BOATMAN",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "619-521-5720",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8585",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAN DIEGO HIGH",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SAN DIEGO HIGH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.