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General NPI Number Information
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NPI Number | 1770049959
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Entity Type | Organization
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Legal Business Name | AZITA HICKEY PH D PSYCHOLOGIST
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 2831 CAMINO DEL RIO S STE 103
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City | SAN DIEGO
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State | CA
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Zip | 92108-3827
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Country | US
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Telephone | 619-880-9008
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Fax | 909-660-4997
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Provider Business Mailing Address
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Address Line | 9921 CARMEL MOUNTAIN RD STE 204
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City | SAN DIEGO
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State | CA
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Zip | 92129-2813
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Country | US
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Telephone | 619-880-9008
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Fax |
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Authorized Official
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Title or Position | OFFICER/PRESIDENT
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Name | AZITA HICKEY
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Credential | PHD
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Telephone | 909-957-0556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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