Healthcare Provider Details

I. General information

NPI: 1457562068
Provider Name (Legal Business Name): ALAN SUGARMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 LA JOLLA VILLAGE DR SUITE 550B
LA JOLLA CA
92037-1402
US

IV. Provider business mailing address

744 MUNEVAR RD
CARDIFF CA
92007-1331
US

V. Phone/Fax

Practice location:
  • Phone: 858-453-5562
  • Fax:
Mailing address:
  • Phone: 760-944-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY7313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: