Healthcare Provider Details

I. General information

NPI: 1851859631
Provider Name (Legal Business Name): RHOMBUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8058 LA MESA BLVD
LA MESA CA
91942-0335
US

IV. Provider business mailing address

8058 LA MESA BLVD
LA MESA CA
91942-0335
US

V. Phone/Fax

Practice location:
  • Phone: 858-848-1766
  • Fax: 619-463-2522
Mailing address:
  • Phone: 858-848-1766
  • Fax: 619-463-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JULIE HAYDEN
Title or Position: EXECUTIVE DIRECTOR
Credential: PSYD
Phone: 858-204-7285