Healthcare Provider Details

I. General information

NPI: 1053417618
Provider Name (Legal Business Name): E. VIRGINIA FOSTER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7848 IVANHOE AVE
LA JOLLA CA
92037-4501
US

IV. Provider business mailing address

1417 PARK ROW
LA JOLLA CA
92037-3711
US

V. Phone/Fax

Practice location:
  • Phone: 858-699-1353
  • Fax: 858-551-2824
Mailing address:
  • Phone: 858-699-1351
  • Fax: 858-551-3824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPSY8202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: