Healthcare Provider Details

I. General information

NPI: 1073933602
Provider Name (Legal Business Name): TRG BUSINESS CONSULTING DYNAMICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 MISSION CENTER CT SUITE 102
SAN DIEGO CA
92108-1319
US

IV. Provider business mailing address

7840 MISSION CENTER CT SUITE 102
SAN DIEGO CA
92108-1319
US

V. Phone/Fax

Practice location:
  • Phone: 619-234-7300
  • Fax: 619-234-0500
Mailing address:
  • Phone: 619-234-7300
  • Fax: 619-234-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberPSY8772
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD BARRY DICKER
Title or Position: OWNER
Credential: PH.D.
Phone: 619-234-7300