Healthcare Provider Details

I. General information

NPI: 1679980239
Provider Name (Legal Business Name): BRITTNEY ANN DEWALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28999 OLD TOWN FRONT STREET SUITE 203
TEMECULA CA
92590
US

IV. Provider business mailing address

10065 OLD GROVE ROAD SUITE 200
SAN DIEGO CA
92131
US

V. Phone/Fax

Practice location:
  • Phone: 858-444-8823
  • Fax: 858-444-8827
Mailing address:
  • Phone: 858-444-8823
  • Fax: 858-444-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1-13-13564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: