MEDICARE: DR. ANNETTE MARIE CONWAY PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY19997	CA

General Provider Information

NPI Number	:	1003852120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNETTE MARIE CONWAY PSYD

Provider Business Mailing Address
First Line	:	3636 4TH AVE STE 304
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4294
Country	:	US
Telephone Number	:	858-481-8827
Fax Number	:	858-244-0990

Provider Business Practice Location Address
First Line	:	3636 4TH AVE STE 304
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4294
Country	:	US
Telephone Number	:	858-482-8827
Fax Number	:	858-244-0990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	12/20/2022

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