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General NPI Number Information
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NPI Number | 1093920530
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Entity Type | Organization
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Legal Business Name | JACQUELINE NEWCOMB
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 16935 W BERNARDO DR SUITE 237
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City | SAN DIEGO
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State | CA
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Zip | 92127-1634
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Country | US
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Telephone | 858-673-3886
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Fax |
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Provider Business Mailing Address
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Address Line | 16174 MESTO DR
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City | SAN DIEGO
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State | CA
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Zip | 92128-3116
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Country | US
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Telephone | 858-673-1283
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JACQUELINE NEWCOMB
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Credential | PH.D.
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Telephone | 858-673-3886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY9865
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License Number State | CA
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