Healthcare Provider Details

I. General information

NPI: 1407392319
Provider Name (Legal Business Name): INSTITUTES OF HEALTH BEHAVIORAL MEDICINE AND MEDICAL PSYCHOLOGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 S EL CAMINO REAL SUITE 100
OCEANSIDE CA
92054-6208
US

IV. Provider business mailing address

4192 GRAYDON RD
SAN DIEGO CA
92130-2116
US

V. Phone/Fax

Practice location:
  • Phone: 858-405-8238
  • Fax:
Mailing address:
  • Phone: 858-405-8238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15744
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA104765
License Number StateCA

VIII. Authorized Official

Name: DR. TOMER ANBAR
Title or Position: DIRECTOR
Credential: PH.D. CGC, CTC
Phone: 858-405-8238