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General NPI Number Information
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NPI Number | 1538620786
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Entity Type | Organization
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Legal Business Name | SAN DIEGO FORENSIC PSYCHOLOGY CORPORATION
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 06/08/2019
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Provider Practice Location Address
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Address Line | 4640 CASS STREET # 90422
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City | SAN DIEGO
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State | CA
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Zip | 92109
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Country | US
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Telephone | 858-274-0874
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 90422
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City | SAN DIEGO
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State | CA
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Zip | 92169-2422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHANDA ANGIOLI
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Credential | PSYCHOLOGIST
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Telephone | 858-274-0874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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