MEDICARE: SAN DIEGO HEALTH PSYCHOLOGY AND WELLNESS

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

General Provider Information

NPI Number	:	1487206850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO HEALTH PSYCHOLOGY AND WELLNESS

Provider Business Mailing Address
First Line	:	2262 CARMEL VALLEY RD STE D
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-3751
Country	:	US
Telephone Number	:	858-240-8400
Fax Number	:	858-429-0640

Provider Business Practice Location Address
First Line	:	2262 CARMEL VALLEY RD STE D
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-3751
Country	:	US
Telephone Number	:	858-240-8400
Fax Number	:	858-429-0640

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SUZANN M KING
Credential	:
Telephone Number	:	619-994-9567

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	01/14/2026

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