Organization
UC TELEHEALTH COLLABORATIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY VAN SLYKE (MANAGER, PROVIDER ENROLLMENT)
(918) 809-2411
Entity
Organization
Contact information
Practice address
6363 GREENWICH DR, SAN DIEGO, CA 92122-5947
(918) 809-2411
Mailing address
6363 GREENWICH DR, SAN DIEGO, CA 92122-5947
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
—
—
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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