DUANGTAVAN SOURIVONG is a methadone clinic center in San Diego, CA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. DUANGTAVAN SOURIVONG NPI is 1285821389. The provider is registered as an organization entity type.
The provider's business location address is:
3940 HOME AVE
SAN DIEGO, CA
ZIP 92105-952
Phone: (619) 262-8000
The provider's authorized official is Bobby Stearns .
The authorized official title is Clinic Director and has the following contact phone number (619) 262-8000.
The enumeration date for this NPI number is 10/2/2007 and was last updated on 10/2/2007.