Healthcare Provider Details

I. General information

NPI: 1871980276
Provider Name (Legal Business Name): MICHAEL HENRI LANGLEY-DEGROOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL HENRI DEGROOT

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR MAIL CODE 0603-R
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

200 W ARBOR DR MAIL CODE 0603-R
SAN DIEGO CA
92103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-4040
  • Fax: 858-822-0231
Mailing address:
  • Phone: 858-534-4040
  • Fax: 858-822-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA147554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: