| Charles V. Ettari, M.d., Inc. | |
|
9834 Genesee Ave La Jolla CA 92037-1223 | |
| (619) 277-9887 | |
| (801) 253-9831 |
| Full Name | Charles V. Ettari, M.d., Inc. |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 9834 Genesee Ave, La Jolla, California |
| Authorized Official Name and Position | Shelly Lynn Daugherty (OFFICE MANAGER) |
| Authorized Official Contact | 6192779887 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles V. Ettari, M.d., Inc. Po Box 2216 Del Mar CA 92014-1516 Ph: (619) 277-9887 | Charles V. Ettari, M.d., Inc. 9834 Genesee Ave La Jolla CA 92037-1223 Ph: (619) 277-9887 |
| NPI Number | 1629098520 |
|---|---|
| Provider Enumeration Date | 07/20/2006 |
| Last Update Date | 03/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629098520 | NPI | - | NPPES |
| OOG167860 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | G16786 (California) | Primary |
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