Individual
CHARLES CLARK ERTL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
10981 SAN DIEGO MISSION RD, SUITE 114, SAN DIEGO, CA 92108-2448
(619) 286-2687
(619) 286-2687
Mailing address
4852 LILA DR, SAN DIEGO, CA 92115-1910
(619) 286-2687
(619) 286-2687
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY15479
CA
Other
Enumeration date
07/10/2006
Last updated
07/08/2007
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