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General NPI Number Information
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NPI Number | 1972655603
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Entity Type | Individual
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Provider Name | MARTIN D CARY PH.D
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 06/25/2009
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Provider Practice Location Address
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Address Line | 4320 LA JOLLA VILLAGE DR SUITE 140
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City | SAN DIEGO
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State | CA
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Zip | 92122-1292
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Country | US
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Telephone | 858-554-6394
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Fax |
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Provider Business Mailing Address
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Address Line | FILE 54433
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City | LOS ANGELES
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State | CA
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Zip | 90074-0001
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Country | US
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Telephone |
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Fax |
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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 | PSY6967
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License Number State | CA
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