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Individual

AMY M DRAHOTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
3020 CHILDREN'S WAY, MC 5042, SAN DIEGO, CA 92123
(858) 966-7453
(858) 966-8011
Mailing address
PO BOX 261705, SAN DIEGO, CA 92196-1705
(858) 966-7703
(858) 966-7704

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
25593
CA
103TB0200X
Cognitive & Behavioral Psychologist
25593
CA
103TC2200X
Clinical Child & Adolescent Psychologist
25593
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12553783
CAQH PROVIDER ID
01
25593
CALIFORNIA BOARD OF PSYCHOLOGY LICENSE
CA
Enumeration date
08/06/2013
Last updated
08/06/2013
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