| Deisy C. Boscan Ph.d. Psychologist Professional Corporation | |
|
7590 Fay Ave Ste 401 La Jolla CA 92037-4872 | |
| (858) 263-4226 | |
| (858) 263-4206 |
| Full Name | Deisy C. Boscan Ph.d. Psychologist Professional Corporation |
|---|---|
| Speciality | Psychologist |
| Location | 7590 Fay Ave Ste 401, La Jolla, California |
| Authorized Official Name and Position | Deisy Cristina Boscan (OWNER) |
| Authorized Official Contact | 8582634226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deisy C. Boscan Ph.d. Psychologist Professional Corporation Po Box 2583 La Jolla CA 92038-2583 Ph: (858) 263-4226 | Deisy C. Boscan Ph.d. Psychologist Professional Corporation 7590 Fay Ave Ste 401 La Jolla CA 92037-4872 Ph: (858) 263-4226 |
| NPI Number | 1144770207 |
|---|---|
| Provider Enumeration Date | 10/12/2016 |
| Last Update Date | 12/14/2021 |
| Certification Date | 12/14/2021 |
| Medicare PECOS PAC ID | 4789090366 |
|---|---|
| Medicare Enrollment ID | O20210305000405 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144770207 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY18873 (California) | Primary |
| Provider Name | Deisy Cristina Boscan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184774325 PECOS PAC ID: 5698181279 Enrollment ID: I20210305000469 |
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