Healthcare Provider Details

I. General information

NPI: 1942731005
Provider Name (Legal Business Name): IVAN S BAROYA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11858 BERNARDO PLAZA CT STE 210
SAN DIEGO CA
92128-2411
US

IV. Provider business mailing address

PO BOX 1770
LA MESA CA
91944-1770
US

V. Phone/Fax

Practice location:
  • Phone: 951-303-6588
  • Fax: 951-303-6588
Mailing address:
  • Phone: 619-622-6916
  • Fax: 951-303-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberA66801
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IVAN BAROYA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-622-6916