| Bruce Yanofsky Phd, Inc. | |
|
224 Landis Ave Chula Vista CA 91910-2609 | |
| (619) 730-9603 | |
| (619) 730-9603 |
| Full Name | Bruce Yanofsky Phd, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 224 Landis Ave, Chula Vista, California |
| Authorized Official Name and Position | Juan F. Madrazo Torres (AUTHORIZED RREPRESENTATIVE) |
| Authorized Official Contact | 6197309603 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruce Yanofsky Phd, Inc. 900 Lane Ave Ste 125 Chula Vista CA 91914-3503 Ph: (619) 240-3377 | Bruce Yanofsky Phd, Inc. 224 Landis Ave Chula Vista CA 91910-2609 Ph: (619) 730-9603 |
| NPI Number | 1861911430 |
|---|---|
| Provider Enumeration Date | 09/15/2017 |
| Last Update Date | 07/17/2023 |
| Certification Date | 07/17/2023 |
| Medicare PECOS PAC ID | 0840558227 |
|---|---|
| Medicare Enrollment ID | O20171212001301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861911430 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Juan F Madrazo Torres |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831353366 PECOS PAC ID: 0941568331 Enrollment ID: I20171212001782 |
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