Healthcare Provider Details

I. General information

NPI: 1740315043
Provider Name (Legal Business Name): NATACHA AKSHOOMOFF PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HIGH BLUFF DRIVE SUITE 215
SAN DIEGO CA
92130
US

IV. Provider business mailing address

1313 WINDSOR ROAD
CARDIFF CA
92007
US

V. Phone/Fax

Practice location:
  • Phone: 760-230-3439
  • Fax: 858-792-8333
Mailing address:
  • Phone: 760-230-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY17720
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: