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General NPI Number Information
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NPI Number | 1124699236
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Entity Type | Organization
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Legal Business Name | SD PSYCHOLOGY, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 7946 IVANHOE AVE STE 310
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City | LA JOLLA
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State | CA
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Zip | 92037-4518
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Country | US
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Telephone | 619-894-1507
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Fax | 858-346-9189
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Provider Business Mailing Address
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Address Line | PO BOX 1521
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City | LA JOLLA
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State | CA
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Zip | 92038-1521
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Country | US
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Telephone | 619-894-1507
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ PSYCHOLOGIST
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Name | DR. STAMATIA DAROGLOU
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Credential | PH.D.
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Telephone | 619-894-1507
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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 |
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License Number State |
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