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General NPI Number Information
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NPI Number | 1073148680
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Entity Type | Organization
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Legal Business Name | AEGIS PSYCHIATRY A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/04/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 4225 EXECUTIVE SQ STE 600
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City | LA JOLLA
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State | CA
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Zip | 92037-1484
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Country | US
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Telephone | 858-866-8444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1770
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City | LA MESA
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State | CA
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Zip | 91944-1770
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Country | US
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Telephone | 858-866-8444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN WANG
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Credential | MD
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Telephone | 858-866-8444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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