Healthcare Provider Details

I. General information

NPI: 1366578494
Provider Name (Legal Business Name): DENNIS GARLAND HUFFMAN PH.D. CLINICAL PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 PARK BLVD STE 105
SAN DIEGO CA
92116-2668
US

IV. Provider business mailing address

4545 PARK BLVD STE 105
SAN DIEGO CA
92116-2668
US

V. Phone/Fax

Practice location:
  • Phone: 619-723-3979
  • Fax: 619-296-8097
Mailing address:
  • Phone: 619-723-3979
  • Fax: 619-296-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 15733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: