1063404614 NPI number — DR. DAVID ARTHUR TANSEY PH.D.

Table of content: DR. DAVID ARTHUR TANSEY PH.D. (NPI 1063404614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063404614 NPI number — DR. DAVID ARTHUR TANSEY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANSEY
Provider First Name:
DAVID
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

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:
1063404614
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 910094
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:
92191-0094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-481-9164
Provider Business Mailing Address Fax Number:
858-481-1004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5520 WELLESLEY ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-4431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-481-9164
Provider Business Practice Location Address Fax Number:
858-481-1004
Provider Enumeration Date:
08/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 5081 , 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)

  • Identifier: 00PL50810 . This is a "BC/BS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00PL50810 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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