Healthcare Provider Details

I. General information

NPI: 1093137887
Provider Name (Legal Business Name): EVA PIROGOVSKY TURK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15644 POMERADO RD STE 305
POWAY CA
92064-2418
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 858-693-3113
  • Fax:
Mailing address:
  • Phone: 858-249-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number26169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: