1760631899 NPI number — DR. DEREK TODD SCHWARTZ PH.D, BCIAC

Table of content: DR. DEREK TODD SCHWARTZ PH.D, BCIAC (NPI 1760631899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760631899 NPI number — DR. DEREK TODD SCHWARTZ PH.D, BCIAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWARTZ
Provider First Name:
DEREK
Provider Middle Name:
TODD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D, BCIAC
Provider Gender Code:
M

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:
1760631899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8813 VILLA LA JOLLA DR
Provider Second Line Business Mailing Address:
STE. 2002
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037-1937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-877-0770
Provider Business Mailing Address Fax Number:
858-452-1517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8813 VILLA LA JOLLA DR
Provider Second Line Business Practice Location Address:
STE. 2002
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-1937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-877-0770
Provider Business Practice Location Address Fax Number:
858-452-1517
Provider Enumeration Date:
09/12/2008

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:  PSY22176 , 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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