Healthcare Provider Details

I. General information

NPI: 1952997926
Provider Name (Legal Business Name): BARRETT HAMILTON NEWSOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SPRING ST STE 104
LA MESA CA
91942-0272
US

IV. Provider business mailing address

1660 HOTEL CIR N STE 101&314
SAN DIEGO CA
92108-2807
US

V. Phone/Fax

Practice location:
  • Phone: 619-782-0700
  • Fax: 619-782-0710
Mailing address:
  • Phone: 619-961-2120
  • Fax: 619-961-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB643750
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: