Healthcare Provider Details

I. General information

NPI: 1851924401
Provider Name (Legal Business Name): JULIE MANOOGIAN PSYD PSYCHOLOGIST APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HIGH BLUFF DR STE 202
SAN DIEGO CA
92130-2053
US

IV. Provider business mailing address

12625 HIGH BLUFF DR STE 202
SAN DIEGO CA
92130-2053
US

V. Phone/Fax

Practice location:
  • Phone: 858-213-1014
  • Fax:
Mailing address:
  • Phone: 858-213-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JULIE MANOOGIAN
Title or Position: PRESIDENT / OWNER
Credential: PSYD
Phone: 858-213-1014