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General NPI Number Information
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NPI Number | 1306375969
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGY CONSULT SERVICES INC
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9834 GENESEE AVE STE 427
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City | LA JOLLA
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State | CA
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Zip | 92037-1264
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Country | US
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Telephone | 858-652-9668
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Fax | 760-230-2206
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Provider Business Mailing Address
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Address Line | 9834 GENESEE AVE STE 427
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City | LA JOLLA
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State | CA
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Zip | 92037-1264
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Country | US
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Telephone | 858-652-9668
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Fax | 760-230-2206
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LESLIE LOWE
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Credential |
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Telephone | 619-203-0003
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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 | PSY21344
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License Number State | CA
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