1073815072 NPI number — DR. KAREN LEE HANSON BONDI PH.D.

Table of content: (NPI 1710932835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073815072 NPI number — DR. KAREN LEE HANSON BONDI PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSON BONDI
Provider First Name:
KAREN
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANSON
Provider Other First Name:
KAREN
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073815072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2240 ENCINITAS BLVD STE D192
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-4345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-876-5511
Provider Business Mailing Address Fax Number:
858-947-4020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12625 HIGH BLUFF DR STE 206
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:
858-876-5511
Provider Business Practice Location Address Fax Number:
858-947-4020
Provider Enumeration Date:
11/23/2010

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: 103G00000X , with the licence number:  PSY23561 , 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)