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General NPI Number Information
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NPI Number | 1538306931
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Entity Type | Organization
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Legal Business Name | INSTITUTE ON VIOLENCE, ABUSE, & TRAUMA @ ALLIANT INTERNATIONAL UNIVERS
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 10065 OLD GROVE RD STE 101
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City | SAN DIEGO
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State | CA
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Zip | 92131-1664
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Country | US
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Telephone | 858-527-1860
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Fax | 858-527-1743
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Provider Business Mailing Address
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Address Line | 10065 OLD GROVE RD STE 101
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City | SAN DIEGO
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State | CA
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Zip | 92131-1664
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Country | US
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Telephone | 858-527-1860
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Fax | 858-527-1743
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Authorized Official
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Title or Position | PRESIDENT/LICENSED PSYCHOLOGIST
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Name | ROBERT GEFFNER
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Credential | PH.D.
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Telephone | 858-527-1860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY16109
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License Number State | CA
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