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General NPI Number Information
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NPI Number | 1881688000
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Entity Type | Individual
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Provider Name | CHARLES ALVIN HOGAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/02/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1415 RIDGEBACK RD
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City | CHULA VISTA
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State | CA
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Zip | 91910-6932
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Country | US
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Telephone | 619-656-3775
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Fax |
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Provider Business Mailing Address
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Address Line | 11815 CAMINITO SANUDO
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City | SAN DIEGO
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State | CA
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Zip | 92131-2103
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Country | US
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Telephone | 619-656-3775
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Fax | 858-549-3146
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PSY7029
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | EB1138
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License Number State | CA
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