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General NPI Number Information
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NPI Number | 1639373491
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Entity Type | Organization
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Legal Business Name | MARJORIE COBURN, PH.D.
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 836 PROSPECT ST SUITE 101
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City | LA JOLLA
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State | CA
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Zip | 92037-4213
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Country | US
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Telephone | 858-456-5065
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Fax |
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Provider Business Mailing Address
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Address Line | 836 PROSPECT ST SUITE 101
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City | LA JOLLA
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State | CA
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Zip | 92037-4213
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Country | US
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Telephone | 858-456-5065
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. MARJORIE FOSTER COBURN
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Credential | PH.D.
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Telephone | 858-456-5065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY8758
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License Number State | CA
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