Healthcare Provider Details

I. General information

NPI: 1255427845
Provider Name (Legal Business Name): MARY HARB SHEETS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 CARMEL MOUNTAIN RD SUITE A
SAN DIEGO CA
92129-2157
US

IV. Provider business mailing address

12803 PIMPERNEL WAY
SAN DIEGO CA
92129-3603
US

V. Phone/Fax

Practice location:
  • Phone: 858-484-8332
  • Fax:
Mailing address:
  • Phone: 858-484-8332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY13803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: