Organization
UNIVERSITY OF CALIFORNIA, SAN DIEGO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA PANNIZON PSY D. (ASSISTANT PROGRAM DIRECTOR)
(619) 542-4156
Entity
Organization
Contact information
Practice address
3851 ROSECRANS ST, SAN DIEGO, CA 92110-3115
(619) 542-4156
Mailing address
11223 PASEO MONTANOSO APT 282, SAN DIEGO, CA 92127-5953
(760) 518-3119
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
390200000
CA
Other
Enumeration date
07/27/2012
Last updated
07/27/2012
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