1538235411 NPI number — DR. SARAH POLSELLI BEYER PH.D.

Table of content: DR. SARAH POLSELLI BEYER PH.D. (NPI 1538235411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538235411 NPI number — DR. SARAH POLSELLI BEYER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEYER
Provider First Name:
SARAH
Provider Middle Name:
POLSELLI
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:
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:
1538235411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2022 ABBOTT ST
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:
92107-2504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-229-8070
Provider Business Mailing Address Fax Number:
619-892-7033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2423 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-961-3800
Provider Business Practice Location Address Fax Number:
619-810-2439
Provider Enumeration Date:
11/24/2006

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:  23883 , 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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