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General NPI Number Information
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NPI Number | 1114125457
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Entity Type | Organization
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Legal Business Name | HERVERY PSYCHOLOGICAL PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/09/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 9606 TIERRA GRANDE ST STE. 107
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City | SAN DIEGO
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State | CA
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Zip | 92126-6501
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Country | US
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Telephone | 858-952-8299
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Fax |
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Provider Business Mailing Address
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Address Line | 9606 TIERRA GRANDE ST STE. 107
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City | SAN DIEGO
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State | CA
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Zip | 92126-6501
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Country | US
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Telephone | 858-952-8299
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND NEUROPSYCHOLOGIST
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Name | DR. AARON HERVEY
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Credential | PH.D.
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Telephone | 858-952-8299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 21292
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License Number State | CA
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