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REGENTS OF THE UNVIERSITY OF CALIFONRIA - UCSD MEDICAL GROUP

Clinical Neuropsychologist

San Diego, California

Provider NPI: 1417059874

Organization Information:
Organization Name:  REGENTS OF THE UNVIERSITY OF CALIFONRIA - UCSD MEDICAL GROUP
Organization is not Subpart
Authorized Official:  MICHAEL DENNIS PRICE  DIRECTOR,REVENUE CYCLE & OPERATIONS  619-5434624

Practice Location:
200 WEST ARBOR DRIVE MC-8201 ATTN: PROVIDER ENROLLMENT DEPARTMENT SAN DIEGO, CA 92103 US
Tel: 619-543-6164  Fax: --

Business Mailing Address:
PO BOX 232410  SAN DIEGO, CA 92193 US
Tel: 619-543-6164  Fax: --

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
N103TB0200XBehavioral Health & Social Service Providers
Psychologist
N103TC0700XBehavioral Health & Social Service Providers
Psychologist
N103TC2200XBehavioral Health & Social Service Providers
Psychologist
Y103T00000XBehavioral Health & Social Service Providers
Psychologist

Other Provider Identifiers:

IssuerNumberStateType
US DEPT OF LABOR36482330201
US DEPT OF LABOR36482330001
US DEPT OF LABOR36482330801
RAILROAD MEDICARECQ402401
US DEPT OF LABOR36482330401
US DEPT OF LABOR36482330301
US DEPT OF LABOR36482330501
US DEPT OF LABOR36482331001
GHPPCGP016905CA01
BLUE SHIELDZZZP3711ZCA01
US DEPT OF LABOR36482330701
US DEPT OF LABOR36482330101
US DEPT OF LABOR36482330601
GPS000030CA05
BLUE SHIELDZZZ73229ZCA01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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