Healthcare Provider Details

I. General information

NPI: 1780374777
Provider Name (Legal Business Name): ANNIKA SKYLER COE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CAMINO DEL RIO S STE 201
SAN DIEGO CA
92108-3505
US

IV. Provider business mailing address

409 CAMINO DEL RIO S STE 201
SAN DIEGO CA
92108-3505
US

V. Phone/Fax

Practice location:
  • Phone: 193-817-7486
  • Fax:
Mailing address:
  • Phone: 619-381-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: