1104026954 NPI number — DR. DEVON BERKHEISER O'NEILL PSY.D.

Table of content: DR. DEVON BERKHEISER O'NEILL PSY.D. (NPI 1104026954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104026954 NPI number — DR. DEVON BERKHEISER O'NEILL PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'NEILL
Provider First Name:
DEVON
Provider Middle Name:
BERKHEISER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERKHEISER
Provider Other First Name:
DEVON
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1104026954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 90247
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:
92169-2247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-337-1213
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3790 VIA DE LA VALLE
Provider Second Line Business Practice Location Address:
SUITE 118E
Provider Business Practice Location Address City Name:
DEL MAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92014-4247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-337-1213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2007

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: 103T00000X , with the licence number:  PSY25621 , 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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