1578621637 NPI number — HARRY C HENDERSON III MD INC

Table of content: DR. CHERYL S. CHITAYAT PSY.D. (NPI 1508088667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578621637 NPI number — HARRY C HENDERSON III MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRY C HENDERSON III MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1578621637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5565 GROSSMONT CENTER DR
Provider Second Line Business Mailing Address:
BUILDING III, SUITE 510
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91942-3020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-464-6051
Provider Business Mailing Address Fax Number:
619-464-2022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5565 GROSSMONT CENTER DR
Provider Second Line Business Practice Location Address:
BUILDING III, SUITE 510
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-464-6051
Provider Business Practice Location Address Fax Number:
619-464-2022
Provider Enumeration Date:
12/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENDERSON
Authorized Official First Name:
HARRY
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
619-464-6051

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)