Healthcare Provider Details

I. General information

NPI: 1083205322
Provider Name (Legal Business Name): SAN DIEGO NEUROPSYCHOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 MANCHESTER SUITE 206
ENCINITAS CA
92024
US

IV. Provider business mailing address

4505 MANCHESTER SUITE 206
ENCINITAS CA
92024
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-9647
  • Fax: 760-944-7491
Mailing address:
  • Phone: 760-944-9647
  • Fax: 760-944-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: LISA ANNE FRANKLIN
Title or Position: BILLING MANAGER
Credential:
Phone: 216-470-4677