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Individual

DR. LUKASZ URBAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSYD

Contact information

Practice address
5252 BALBOA AVE STE 1004, SAN DIEGO, CA 92117
(619) 314-5560
Mailing address
5252 BALBOA AVE STE 1004, SAN DIEGO, CA 92117-6986
(619) 314-5560

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PSY30225
CA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY30225
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
83-1489014
EMPLOYEE ID NUMBER
CA
01
PSY30225
PSYCHOLOGY LICENSE
CA
Enumeration date
08/16/2011
Last updated
08/24/2018
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