Healthcare Provider Details

I. General information

NPI: 1548762388
Provider Name (Legal Business Name): ANA THOMAT, PH.D., PSYCHOLOGIST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3368 2ND AVE STE C1
SAN DIEGO CA
92103-5666
US

IV. Provider business mailing address

3368 2ND AVE STE C1
SAN DIEGO CA
92103-5666
US

V. Phone/Fax

Practice location:
  • Phone: 619-880-6690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number29679
License Number StateCA

VIII. Authorized Official

Name: ANA THOMAT
Title or Position: PRESIDENT
Credential:
Phone: 619-880-6690