Healthcare Provider Details

I. General information

NPI: 1366471237
Provider Name (Legal Business Name): JAMES ROBERT EARNEST PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 VIEWRIDGE AVE STE 230
SAN DIEGO CA
92123-1658
US

IV. Provider business mailing address

919 N SUNSET AVE
WEST COVINA CA
91790-1244
US

V. Phone/Fax

Practice location:
  • Phone: 800-257-8715
  • Fax: 800-819-1655
Mailing address:
  • Phone: 800-257-8715
  • Fax: 800-819-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 8523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: