Healthcare Provider Details

I. General information

NPI: 1265820302
Provider Name (Legal Business Name): DR. LINDSEY HOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 10/23/2021
Certification Date: 10/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9666 BUSINESSPARK AVE SUITE 207
SAN DIEGO CA
92131-1646
US

IV. Provider business mailing address

9666 BUSINESSPARK AVE SUITE 207
SAN DIEGO CA
92131-1646
US

V. Phone/Fax

Practice location:
  • Phone: 858-549-3347
  • Fax:
Mailing address:
  • Phone: 858-549-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number25706
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number25706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: