Healthcare Provider Details

I. General information

NPI: 1558489591
Provider Name (Legal Business Name): JOSEPH HENRY BRATSKY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 HOLIDAY CT STE 106
LA JOLLA CA
92037-1807
US

IV. Provider business mailing address

3252 HOLIDAY CT. #106
LA JOLLA CA
92037-1807
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8181
  • Fax: 858-552-0205
Mailing address:
  • Phone: 858-552-8181
  • Fax: 858-552-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY7112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: