| |
3200 4th Ave Ste 100 San Diego CA 92103-5716 | |
(619) 293-3994 | |
(619) 260-1048 |
Full Name | |
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Speciality | Clinical Neuropsychologist |
Location | 3200 4th Ave Ste 100, San Diego, California |
Authorized Official Name and Position | Catherine J Ward (SECRETARY / PSYCHOLOGIST) |
Authorized Official Contact | 6192933994 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3200 4th Ave Ste 100 San Diego CA 92103-5716 Ph: (619) 293-3994 | 3200 4th Ave Ste 100 San Diego CA 92103-5716 Ph: (619) 293-3994 |
NPI Number | 1902572167 |
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Provider Enumeration Date | 08/18/2021 |
Last Update Date | 04/02/2024 |
Certification Date | 04/02/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902572167 | NPI | - | NPPES |
1952608093 | Other | CA | NPI |
PSY30926 | Other | CA | STATE LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
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