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Organization
RENOVA SAN DIEGO
Active
Organization
RENOVA SAN DIEGO
Active
Other names
DR BEN INOUYE AND DR LISA J PALMER FOUNDATION FOR FAMILY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCHITA MASTERS PSY.D. (DIRECTOR OF CLINICAL PSYCH PROGRAM)
(858) 722-4372
Entity
Organization
Contact information
Practice address
12396 WORLD TRADE DR STE 109, SAN DIEGO, CA 92128-3787
(619) 895-0509
Mailing address
12396 WORLD TRADE DR STE 109, SAN DIEGO, CA 92128-3787
(858) 722-4372
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
—
NULL
103TP2701X
Group Psychotherapy Psychologist
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
08/11/2022
Last updated
09/18/2026
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