Healthcare Provider Details

I. General information

NPI: 1417394669
Provider Name (Legal Business Name): ELIANA HURWICH-REISS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 KEARNY VILLA RD STE 200
SAN DIEGO CA
92123-1954
US

IV. Provider business mailing address

4231 BALBOA AVE STE 3045
SAN DIEGO CA
92117-5504
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-7703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: