1518073501 NPI number — DR. ADRIENNE MCFADD PH.D.

Table of content: DR. ADRIENNE MCFADD PH.D. (NPI 1518073501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518073501 NPI number — DR. ADRIENNE MCFADD PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCFADD
Provider First Name:
ADRIENNE
Provider Middle Name:
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:
FERRELL
Provider Other First Name:
ADRIENNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1518073501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4550 KEARNY VILLA RD
Provider Second Line Business Mailing Address:
SUITE 214
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-1578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-977-1748
Provider Business Mailing Address Fax Number:
858-492-1246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4550 KEARNY VILLA RD
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-1578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-977-1748
Provider Business Practice Location Address Fax Number:
858-492-1246
Provider Enumeration Date:
08/22/2006

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:  PSY5602 , 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: PSY056020 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com