Healthcare Provider Details

I. General information

NPI: 1881927184
Provider Name (Legal Business Name): MR. ALAN BOND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 CENTRE ST
SAN DIEGO CA
92103-3410
US

IV. Provider business mailing address

3909 CENTRE ST
SAN DIEGO CA
92103-3410
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-2077
  • Fax: 619-718-6447
Mailing address:
  • Phone: 619-692-2077
  • Fax: 619-718-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number25805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: