MEDICARE: DR. MARGARET VERNON PH.E.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY4659	CA

General Provider Information

NPI Number	:	1003806589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGARET VERNON PH.E.

Provider Business Mailing Address
First Line	:	2231 CAMINO DEL RIO S
Second Line	:	STE 308
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3612
Country	:	US
Telephone Number	:	619-281-5521
Fax Number	:	619-260-3054

Provider Business Practice Location Address
First Line	:	2231 CAMINO DEL RIO S
Second Line	:	STE 308
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3612
Country	:	US
Telephone Number	:	619-281-5521
Fax Number	:	619-260-3054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	10/18/2011

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