Healthcare Provider Details

I. General information

NPI: 1669401360
Provider Name (Legal Business Name): MICHAEL HOWARD KABAT PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 GENESEE AVE SUITE 427
LA JOLLA CA
92037-1223
US

IV. Provider business mailing address

2356 CAMBRIDGE AVE
CARDIFF CA
92007-2002
US

V. Phone/Fax

Practice location:
  • Phone: 858-652-9668
  • Fax:
Mailing address:
  • Phone: 410-258-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number21344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: