JR'S TRAUMA CARE INITIATIVE NPI 1205401593

NPI Information

  • NPI: 1205401593
  • Provider Name: JR'S TRAUMA CARE INITIATIVE
  • Classification: Clinic/Center - 261QM0801X
  • Specialization: Mental Health (Including Community Mental Health Center)
  • Entity Type: Organization
  • Address: 1665 PRECISION PARK LN STE H
    SAN YSIDRO, CA
    ZIP 92173
  • Phone: (619) 330-7569

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NPI Details

JR'S TRAUMA CARE INITIATIVE is a mental health (including community mental health center) clinic center in San Ysidro, CA. JR'S TRAUMA CARE INITIATIVE NPI is 1205401593. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1665 PRECISION PARK LN STE H
SAN YSIDRO, CA
ZIP 92173-348
Phone: (619) 330-7569

The provider's authorized official is Charles Elmer Walker .
The authorized official title is Director Of Mental Health and has the following contact phone number (619) 330-7569.

The enumeration date for this NPI number is 5/20/2021 and was last updated on 5/20/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YM0800XCounselorMental HealthNo
21041C0700XSocial WorkerClinicalNo
3106H00000XMarriage & Family TherapistNo
4261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)Yes
5261QM0855XClinic/CenterAdolescent and Children Mental HealthNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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