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Individual

MARK A AMPARO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
5222 BALBOA AVE STE 33, SAN DIEGO, CA 92117-6953
(858) 874-8868
Mailing address
PO BOX 939043, SAN DIEGO, CA 92193-9043

Taxonomy

Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
91202202F80050
CA
Enumeration date
04/05/2020
Last updated
04/05/2020
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