Healthcare Provider Details

I. General information

NPI: 1962273201
Provider Name (Legal Business Name): CLOUD NINE CLINICAL CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 MANCHESTER AVE STE 207
ENCINITAS CA
92024-7902
US

IV. Provider business mailing address

PO BOX 230547
ENCINITAS CA
92023-0547
US

V. Phone/Fax

Practice location:
  • Phone: 760-730-2535
  • Fax: 760-230-4199
Mailing address:
  • Phone: 619-218-2858
  • Fax: 760-230-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL SARGENT
Title or Position: CEO
Credential: MD
Phone: 760-730-2535