1083906408 NPI number — ACCURATE ASSESSMENTS OF SAN DIEGO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083906408 NPI number — ACCURATE ASSESSMENTS OF SAN DIEGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCURATE ASSESSMENTS OF SAN DIEGO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083906408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12625 HIGH BLUFF DR STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92130-2053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-208-9689
Provider Business Mailing Address Fax Number:
858-793-1124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12625 HIGH BLUFF DR STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92130-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-208-9689
Provider Business Practice Location Address Fax Number:
858-793-1124
Provider Enumeration Date:
05/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JAFFE
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
858-208-9689

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY18811 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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