OrganizationActive
Coastal Detox of Southern California LLC
NPI 1003536830 · Substance Abuse Rehabilitation Facility · San Diego, CA
Provider details
- NPI number
- 1003536830
- Entity type
- Organization
- Primary specialty
- Substance Abuse Rehabilitation FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Mercedes Cornejo, Ceo(619) 386-7740
Specialties & taxonomies
Residential Treatment Facilities
Profile Score
Established profile(60/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2574 Pico Way
San Diego, CA 92109-3811
Phone: (619) 386-7740
Street-level locationGet directions
Mailing address
2574 Pico Way
San Diego, CA 92109-3811
Registry dates
- Enumerated
- 2022-08-31
- Last updated
- 2025-05-30
- Certified
- 2025-05-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.