Puente de Vida

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

Legal business name

PUENTE DE VIDA

Practice address

3013 Woodford Dr
La Jolla, CA 92037-3549

Phone

(858) 452-3915

Fax

(858) 452-1798

NPI assigned

Mar 14, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Stephen E. Schaefer, L.C.S.W.

Title

President

Phone

(858) 452-3915

Specialties & licenses 1

Addresses

Tax ID family

Eating Disorder Center of Fresno3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Puente de Vida, Inc

  • Community/Behavioral Health Agency
  • Fresno, CA
  • NPI 1194160275
  NPD tax ID
• Puente de Vida, Inc

  • Psychiatric Residential Treatment Facility
  • San Diego, CA
  • NPI 1265737829
  NPD tax ID

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881728954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86020",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921386020",
            "telephone_number": "858-452-3915",
            "fax_number": "858-452-1798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3013 WOODFORD DR",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920373549",
            "telephone_number": "858-452-3915",
            "fax_number": "858-452-1798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUENTE DE VIDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHAEFER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-452-3915",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.C.S.W."
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chris Proud, DC
• Juliana Provencio
• Ryan Thomas Pruente, MD
• Trina Psenicnik, L.AC.
• Psychology Center, Inc.
• Andrew Puett, MD, PHD
• Ernest E Pund Jr., MD
• Christina Suzanne Purdy, AGACNP-BC
• Cynthia A. Purviance, M.D.
• Lukas John Pytlik, DDS

• Psychiatric Residential Treatment Facility in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Psychiatric Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.