Healthcare Provider Details

I. General information

NPI: 1588879720
Provider Name (Legal Business Name): AARON LEE CANNON PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 4TH AVE
SAN DIEGO CA
92103-4913
US

IV. Provider business mailing address

750 B ST STE 2870
SAN DIEGO CA
92101-8132
US

V. Phone/Fax

Practice location:
  • Phone: 619-722-0014
  • Fax: 619-327-4174
Mailing address:
  • Phone: 619-722-0014
  • Fax: 619-327-4174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: