| Azita Hickey Ph D Psychologist | |
|
2831 Camino Del Rio S Ste 103 San Diego CA 92108-3827 | |
| (619) 880-9008 | |
| (909) 660-4997 |
| Full Name | Azita Hickey Ph D Psychologist |
|---|---|
| Speciality | Psychologist |
| Location | 2831 Camino Del Rio S Ste 103, San Diego, California |
| Authorized Official Name and Position | Azita Hickey (OFFICER/PRESIDENT) |
| Authorized Official Contact | 9099570556 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Azita Hickey Ph D Psychologist 9921 Carmel Mountain Rd Ste 204 San Diego CA 92129-2813 Ph: (619) 880-9008 | Azita Hickey Ph D Psychologist 2831 Camino Del Rio S Ste 103 San Diego CA 92108-3827 Ph: (619) 880-9008 |
| NPI Number | 1770049959 |
|---|---|
| Provider Enumeration Date | 02/13/2019 |
| Last Update Date | 04/29/2024 |
| Certification Date | 04/29/2024 |
| Medicare PECOS PAC ID | 8729317078 |
|---|---|
| Medicare Enrollment ID | O20190911001843 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770049959 | NPI | - | NPPES |
| PSY30683 | Other | CA | LICENSE, CLINICAL PSYCHOLOGIST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Azita Melody Hickey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548520554 PECOS PAC ID: 4082943337 Enrollment ID: I20190911001988 |
| Provider Name | Emily Essid |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043772064 PECOS PAC ID: 5698110773 Enrollment ID: I20240228002682 |
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