Healthcare Provider Details

I. General information

NPI: 1598740623
Provider Name (Legal Business Name): ERIC EDWARD CUNHA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON BLDG H100
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

4968 DULIN RD
FALLBROOK CA
92028-7832
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1555
  • Fax: 760-725-1350
Mailing address:
  • Phone: 760-725-1555
  • Fax: 760-725-1350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 14724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: