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General NPI Number Information
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NPI Number | 1578871786
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Entity Type | Organization
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Legal Business Name | DELBERT L. SECRIST JR. M.D. A MEDICAL CORP.
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 141 N. ACACIA AVE. STE A
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City | SOLANA BEACH
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State | CA
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Zip | 92015-1130
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Country | US
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Telephone | 858-755-9324
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Fax | 760-751-9067
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Provider Business Mailing Address
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Address Line | 141 N. ACACIA AVE STE A
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City | SOLANA BEACH
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State | CA
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Zip | 92015-1130
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Country | US
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Telephone | 858-755-9324
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Fax | 760-751-9067
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Authorized Official
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Title or Position | OWNER
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Name | DR. DELBERT L. SECRIST JR. M.D JR.
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Credential |
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Telephone | 858-755-9324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G12084
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License Number State | CA
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