Healthcare Provider Details

I. General information

NPI: 1992348403
Provider Name (Legal Business Name): DR. DEVIN R DIHENIA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 VISTA HILL AVE
SAN DIEGO CA
92123-2717
US

IV. Provider business mailing address

7850 VISTA HILL AVE
SAN DIEGO CA
92123-2717
US

V. Phone/Fax

Practice location:
  • Phone: 619-215-1797
  • Fax:
Mailing address:
  • Phone: 619-215-1797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: