| San Diego Medical Pain And Trama Institute | |
|
5405 Morehouse Dr Ste 120 San Diego CA 92121-4723 | |
| (442) 777-2040 | |
| (858) 408-4494 |
| Full Name | San Diego Medical Pain And Trama Institute |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 5405 Morehouse Dr Ste 120, San Diego, California |
| Authorized Official Name and Position | Tracey Lynn Chester (FOUNDER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 8585313795 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Diego Medical Pain And Trama Institute 5965 Village Way. Suite 105 #112 San Diego CA 92130 Ph: (442) 777-2040 | San Diego Medical Pain And Trama Institute 5405 Morehouse Dr Ste 120 San Diego CA 92121-4723 Ph: (442) 777-2040 |
| NPI Number | 1629692397 |
|---|---|
| Provider Enumeration Date | 05/29/2020 |
| Last Update Date | 05/25/2021 |
| Certification Date | 05/25/2021 |
| Medicare PECOS PAC ID | 6305254590 |
|---|---|
| Medicare Enrollment ID | O20210428002223 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629692397 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Shannon K Richmond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720422934 PECOS PAC ID: 5395016448 Enrollment ID: I20170808000897 |
| Provider Name | Gabriela Hirsch Kerbel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609378637 PECOS PAC ID: 9638424393 Enrollment ID: I20180620002079 |
| Provider Name | Ryan A Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467976431 PECOS PAC ID: 6901205558 Enrollment ID: I20210601002667 |
| Provider Name | Mackenzie A Hudson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417248303 PECOS PAC ID: 0749676815 Enrollment ID: I20220330001145 |
| Provider Name | Rodrigo N Franco |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952736043 PECOS PAC ID: 1153550884 Enrollment ID: I20220721000855 |
| Provider Name | Tracey L Chester |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1740549658 PECOS PAC ID: 9739597923 Enrollment ID: I20240119001290 |
| Provider Name | Catherine C Beery |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1760535041 PECOS PAC ID: 3274978416 Enrollment ID: I20240228001023 |
| Provider Name | Natalie L Small |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1871949180 PECOS PAC ID: 4688016215 Enrollment ID: I20240528001646 |
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