Healthcare Provider Details

I. General information

NPI: 1164893442
Provider Name (Legal Business Name): URI KUGEL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 CARROLL CANYON RD STE 100
SAN DIEGO CA
92121-1779
US

IV. Provider business mailing address

7462 BRENTWOOD ST
SAN DIEGO CA
92111-4330
US

V. Phone/Fax

Practice location:
  • Phone: 510-213-8740
  • Fax:
Mailing address:
  • Phone: 510-213-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: