Healthcare Provider Details

I. General information

NPI: 1235100959
Provider Name (Legal Business Name): GERALD ALLEN VERNON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ROSECRANS ST BLDG 500
SAN DIEGO CA
92106-4408
US

IV. Provider business mailing address

14185 MANGO DR
DEL MAR CA
92014-2924
US

V. Phone/Fax

Practice location:
  • Phone: 619-553-0426
  • Fax: 619-553-8945
Mailing address:
  • Phone: 619-553-0426
  • Fax: 619-553-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY5995
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY5995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: