Healthcare Provider Details

I. General information

NPI: 1144428467
Provider Name (Legal Business Name): JOANNE M. HAMILTON PSYCHOLOGIST A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2007
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9968 HIBERT ST STE 105
SAN DIEGO CA
92131-1036
US

IV. Provider business mailing address

9968 HIBERT ST STE 105
SAN DIEGO CA
92131-1036
US

V. Phone/Fax

Practice location:
  • Phone: 858-693-3113
  • Fax: 858-312-8460
Mailing address:
  • Phone: 858-693-3113
  • Fax: 858-312-8460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number18998
License Number StateCA

VIII. Authorized Official

Name: DR. JOANNE MARIE HAMILTON
Title or Position: SOLE OWNER
Credential: PHD
Phone: 858-693-3113