Healthcare Provider Details

I. General information

NPI: 1629139498
Provider Name (Legal Business Name): DAVID JOSEPH LOOMIS II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 02/23/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210735 C STREET
CAMP PENDLETON CA
92058
US

IV. Provider business mailing address

1143 YORK DR
VISTA CA
92084-7251
US

V. Phone/Fax

Practice location:
  • Phone: 626-253-6948
  • Fax:
Mailing address:
  • Phone: 626-253-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1576
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: