Healthcare Provider Details

I. General information

NPI: 1124293261
Provider Name (Legal Business Name): JOHN L. SEXTON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DRIVE #0304 PSYCHOLOGICAL SERVICES
LA JOLLA CA
92093-0304
US

IV. Provider business mailing address

3109 MORNING WAY
LA JOLLA CA
92037-1902
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-3755
  • Fax:
Mailing address:
  • Phone: 858-587-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 19545
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 19545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: