Healthcare Provider Details

I. General information

NPI: 1952756397
Provider Name (Legal Business Name): VARUN MOHAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8989 RIO SAN DIEGO DR STE 200
SAN DIEGO CA
92108-1647
US

IV. Provider business mailing address

8989 RIO SAN DIEGO DR STE 200
SAN DIEGO CA
92108-1647
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A18873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: