Healthcare Provider Details

I. General information

NPI: 1760699714
Provider Name (Legal Business Name): SOUTHCOAST PSYCHOLOGICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 PALOMAR AIRPORT RD 205
CARLSBAD CA
92011-1430
US

IV. Provider business mailing address

7373 UNIVERSITY AVE 213
LA MESA CA
91941-6000
US

V. Phone/Fax

Practice location:
  • Phone: 949-248-0508
  • Fax:
Mailing address:
  • Phone: 619-464-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. VESNA RADOJEVIC
Title or Position: OWNER
Credential: PHD
Phone: 949-248-0508