Healthcare Provider Details

I. General information

NPI: 1316122625
Provider Name (Legal Business Name): COLLEEN ALSPAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 RUFFIN RD SUITE 100
SAN DIEGO CA
92123-1880
US

IV. Provider business mailing address

3635 RUFFIN RD SUITE 100
SAN DIEGO CA
92123-1880
US

V. Phone/Fax

Practice location:
  • Phone: 858-300-0460
  • Fax: 858-300-0461
Mailing address:
  • Phone: 858-300-0460
  • Fax: 858-300-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: