Organization
CHARLES V. ETTARI, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHELLY LYNN DAUGHERTY (OFFICE MANAGER)
(619) 277-9887
Entity
Organization
Contact information
Practice address
9834 GENESEE AVE, LA JOLLA, CA 92037-1223
(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
—
OOG167860
—
CA
Enumeration date
07/20/2006
Last updated
03/04/2015
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