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Organization
PSYCHSANDIEGO
Active
Organization
PSYCHSANDIEGO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTINE DYKES (OFFICE MANAGER)
(858) 531-4960
Entity
Organization
Contact information
Practice address
311 LAUREL ST, SAN DIEGO, CA 92101-1630
(858) 531-4960
Mailing address
311 LAUREL ST, SAN DIEGO, CA 92101-1630
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PSY19734
CA
103TC0700X
Clinical Psychologist
Primary
PSY20775
CA
103TC0700X
Clinical Psychologist
PSY21690
CA
103TC0700X
Clinical Psychologist
PSY21903
CA
Other
Enumeration date
05/06/2010
Last updated
05/06/2010
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