Healthcare Provider Details

I. General information

NPI: 1306375969
Provider Name (Legal Business Name): NEUROPSYCHOLOGY CONSULT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 GENESEE AVE STE 427
LA JOLLA CA
92037-1264
US

IV. Provider business mailing address

9834 GENESEE AVE STE 427
LA JOLLA CA
92037-1264
US

V. Phone/Fax

Practice location:
  • Phone: 858-652-9668
  • Fax: 760-230-2206
Mailing address:
  • Phone: 858-652-9668
  • Fax: 760-230-2206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY21344
License Number StateCA

VIII. Authorized Official

Name: LESLIE LOWE
Title or Position: OFFICE MANAGER
Credential:
Phone: 619-203-0003