Individual
DR. CHARLES VINCENT ETTARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9888 GENESEE AVE, LA JOLLA, CA 92037-1205
(619) 277-9887
(801) 253-9831
Mailing address
PO BOX 2216, DEL MAR, CA 92014-1516
(619) 277-9887
(801) 253-9831
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
G16786
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OOG 167860
—
CA
Enumeration date
07/17/2006
Last updated
11/23/2019
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