MEDICARE: DR. CARREN JEAN STIKA PH.D.

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	103TC0700X	Clinical Psychologist	13613	CA
2	103TF0200X	Forensic Psychologist
3	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1457371924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARREN JEAN STIKA PH.D.

Provider Business Mailing Address
First Line	:	3821 FRONT ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3019
Country	:	US
Telephone Number	:	619-794-2059
Fax Number	:

Provider Business Practice Location Address
First Line	:	3821 FRONT ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3019
Country	:	US
Telephone Number	:	619-794-2059
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	12/05/2014

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