MEDICARE: DR. E. WARREN O'MEARA PH.D.

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	PSY8654	CA

General Provider Information

NPI Number	:	1124185947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. E. WARREN O'MEARA PH.D.

Provider Business Mailing Address
First Line	:	10755 SCRIPPS POWAY PKWY STE F
Second Line	:	SUITE 111
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3924
Country	:	US
Telephone Number	:	858-566-0123
Fax Number	:	858-566-0050

Provider Business Practice Location Address
First Line	:	10755 SCRIPPS POWAY PKWY STE F
Second Line	:	SUITE 111
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3924
Country	:	US
Telephone Number	:	858-566-0123
Fax Number	:	858-566-0050

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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