Individual
ALBERT MODAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1211 PUERTA DEL SOL, SAN CLEMENTE, CA 92673-6306
(949) 276-5553
Mailing address
823 GATEWAY CENTER WAY, SAN DIEGO, CA 92102-4541
(619) 906-4623
(619) 906-4564
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
29697
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39
STUDENT IN A HEALTH CARE TRAINING PROGRAM
CA
Enumeration date
07/20/2015
Last updated
10/23/2024
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