Provider Demographics
NPI:1538355771
Name:UCSD OUTPATIENT PSYCHIATIC CLINIC
Entity type:Organization
Organization Name:UCSD OUTPATIENT PSYCHIATIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTHER
Authorized Official - Suffix:
Authorized Official - Credentials:SW INTERN
Authorized Official - Phone:619-497-6645
Mailing Address - Street 1:140 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2007
Mailing Address - Country:US
Mailing Address - Phone:619-497-6645
Mailing Address - Fax:619-497-6686
Practice Address - Street 1:140 ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2007
Practice Address - Country:US
Practice Address - Phone:619-497-6645
Practice Address - Fax:619-497-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization