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NPI Code Detail

MEDICARE: DR. LUCKVIN PONSINGH MANUEL M.D.

MEDICARE: DR. LUCKVIN PONSINGH MANUEL M.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
12084P0804XChild & Adolescent Psychiatry PhysicianA89173CA
22084P0800XPsychiatry PhysicianA89173CA

General Provider Information

NPI Number : 1699857813
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LUCKVIN PONSINGH MANUEL M.D.
Provider Business Mailing Address
First Line : 1260 MORENA BLVD STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-3850
Country : US
Telephone Number : 619-398-0355
Fax Number : 619-398-0350
Provider Business Practice Location Address
First Line : 1260 MORENA BLVD STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-3850
Country : US
Telephone Number : 619-398-0355
Fax Number : 619-398-0350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 03/15/2011

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