Healthcare Provider Details

I. General information

NPI: 1265765440
Provider Name (Legal Business Name): COLLEEN K. HOBLIT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2009
Last Update Date: 09/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9404 GENESEE AVE SUITE 335
LA JOLLA CA
92037-1339
US

IV. Provider business mailing address

9404 GENESEE AVE SUITE 335
LA JOLLA CA
92037-1339
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-9393
  • Fax:
Mailing address:
  • Phone: 858-552-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY14331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: