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General NPI Number Information
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NPI Number | 1285358143
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Entity Type | Organization
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Legal Business Name | MARK W. BONDI, PHD, ABPP-CN, PSYCHOLOGIST, APC
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 12625 HIGH BLUFF DR STE 206
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City | SAN DIEGO
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State | CA
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Zip | 92130-2053
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Country | US
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Telephone | 858-333-4261
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 ENCINITAS BLVD STE D192
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City | ENCINITAS
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State | CA
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Zip | 92024-4345
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Country | US
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Telephone | 858-333-4261
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | KAREN LEE HANSON BONDI
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Credential | PHD
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Telephone | 858-333-4261
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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 |
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License Number State |
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