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DUANGTAVAN SOURIVONG
NPI 1285821389
Clinic/Center - Methadone in San Diego, CA

Active since October 02, 2007
3940 HOME AVE, SAN DIEGO, CA 92105(619) 262-8000 Get Directions Write a Review

NPPES record last updated: October 2, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Duangtavan Sourivong NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DUANGTAVAN SOURIVONG (NPI 1285821389) is a healthcare organization registered as a methadone in San Diego, California and active in the NPI registry since October 2007. The organization lists Bobby Stearns, Clinic Director, as its authorized official.

NPPES Registry Identity

NPI1285821389
Entity TypeOrganization
Primary Taxonomy261QM2800X
Legal Business NameDUANGTAVAN SOURIVONG
Location Address3940 HOME AVESan Diego, CA 92105-5952
Mailing Address4852 Jarrett CtSan Diego, CA 92113-3598
Phone(619) 262-8000
Organization SubpartNo
Authorized OfficialBobby StearnsClinic Director · (619) 262-8000
Enumeration DateOctober 2, 2007
✔ NPI 1285821389 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · MethadoneAmbulatory Health Care Facilities
Taxonomy Code261QM2800X
Definition
An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.
3940 HOME AVE, San Diego, CA 92105
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KARLA JEAN LIGHTNER
Counselor (Addiction (Substance Use Disorder))
3940 HOME AVE
SAN DIEGO, CA 92105
San Diego County (619) 262-8000
CHARYL LORRAINE CRAWFORD LVN
Licensed Practical Nurse
3940 HOME AVE
SAN DIEGO, CA 92105
San Diego County (619) 262-8000
CRC HOME AVENUE CLINIC
Clinic/Center (Methadone)
3940 HOME AVE
SAN DIEGO, CA 92105
San Diego County (619) 262-8800
MARLENE FRANZ
Licensed Vocational Nurse
3940 HOME AVE
SAN DIEGO, CA 92105
San Diego County (619) 262-8000
DARLENE MARIE GOLDNER B.S.,RRW
Counselor (Addiction (Substance Use Disorder))
3940 HOME AVE
SAN DIEGO, CA 92105
San Diego County (619) 262-8000
LINDA PATRICIA BROMLEY RRW
Counselor (Addiction (Substance Use Disorder))
3940 HOME AVE
SAN DIEGO, CA 92105
San Diego County (619) 262-8000
JEREMY STEWART CLOOKIE FNP
Nurse Practitioner (Family)
3940 HOME AVE
SAN DIEGO, CA 92105
San Diego County (619) 262-8000
ZUJHEI LEON
Counselor (Addiction (Substance Use Disorder))
3940 HOME AVE
SAN DIEGO, CA 92105
San Diego County (619) 262-8800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Duangtavan Sourivong's NPI number?

The NPI number for Duangtavan Sourivong is 1285821389. It was assigned to this organization in the NPPES registry on October 2, 2007.

Where is Duangtavan Sourivong located?

Duangtavan Sourivong is located at 3940 Home Ave, San Diego, CA 92105. The listed phone number is (619) 262-8000.

What is Duangtavan Sourivong's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Methadone, with taxonomy code 261QM2800X.

When was this NPI record last updated?

The NPPES record for Duangtavan Sourivong was last updated on October 2, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.