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General NPI Number Information
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NPI Number | 1811386402
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Entity Type | Organization
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Legal Business Name | PACIFIC NEUROHEALTH, A PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 80 EUREKA SQ SUITE 218
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City | PACIFICA
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State | CA
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Zip | 94044-2654
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Country | US
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Telephone | 650-245-5503
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Fax |
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Provider Business Mailing Address
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Address Line | 80 EUREKA SQ SUITE 218
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City | PACIFICA
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State | CA
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Zip | 94044-2654
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Country | US
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Telephone | 650-245-5503
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL COLE
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Credential | PHD
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Telephone | 650-245-5503
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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 | PSY 22834
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License Number State | CA
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