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3455 Ingraham St San Diego CA 92109-6713 | |
| (619) 937-2055 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3455 Ingraham St, San Diego, California |
| Authorized Official Name and Position | Lisa Carolyn Mcjunkin (COO) |
| Authorized Official Contact | 6199870158 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4860 Muir Ave San Diego CA 92107-2102 Ph: (619) 937-2055 | 3455 Ingraham St San Diego CA 92109-6713 Ph: (619) 937-2055 |
| NPI Number | 1003681396 |
|---|---|
| Provider Enumeration Date | 11/16/2023 |
| Last Update Date | 01/25/2024 |
| Certification Date | 01/25/2024 |
| Medicare PECOS PAC ID | 7416393475 |
|---|---|
| Medicare Enrollment ID | O20240312004120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003681396 | NPI | - | NPPES |
| Provider Name | Paul D Sargent |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609990662 PECOS PAC ID: 6204018948 Enrollment ID: I20110316000756 |
| Provider Name | Olivia Kozarev |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003211343 PECOS PAC ID: 2567720527 Enrollment ID: I20171220001783 |
| Provider Name | Arsalan Azam |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487053336 PECOS PAC ID: 8123311776 Enrollment ID: I20191231001197 |
| Provider Name | Robert K Donaldson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1922312875 PECOS PAC ID: 6709222631 Enrollment ID: I20240313002575 |
| Provider Name | Lisa C Mcjunkin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1215060991 PECOS PAC ID: 4789020744 Enrollment ID: I20240327002795 |
| Provider Name | Samuel W Schulze |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134952625 PECOS PAC ID: 7810422706 Enrollment ID: I20241202002648 |
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