Healthcare Provider Details

I. General information

NPI: 1194872762
Provider Name (Legal Business Name): JAMES R FIX PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 CUDAHY PL SUITE 314
SAN DIEGO CA
92110-3931
US

IV. Provider business mailing address

1094 CUDAHY PL SUITE 314
SAN DIEGO CA
92110-3931
US

V. Phone/Fax

Practice location:
  • Phone: 619-276-8112
  • Fax: 619-276-8230
Mailing address:
  • Phone: 619-276-8112
  • Fax: 619-276-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 18312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: